Efficacy of Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors in Non-Ischemic Dilated Cardiomyopathy: A Systematic Review and Meta-Analysis.

Background: Non-ischemic dilated cardiomyopathy (NIDCM) is a form of heart failure with a poor prognosis and unclear optimal management. The aim of the study was to systematically review the literature and assess the efficacy and safety of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in the management of chronic heart failure secondary to NIDCM and explore their putative mechanisms of action. Methods: Studies from 1990 to 2023 were reviewed using PubMed and EMBASE, focusing on their effects on left ventricular ejection fraction (LVEF) in NIDCM patients, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Beta-blockers showed a significant beneficial effect on LVEF improvement in NIDCM, with an overall effect size of Cohen's d = 1.30, 95% confidence interval (CI) (0.76, 1.84), high heterogeneity (Tau2 = 0.90; Chi2 = 162.05, df = 13, P < 0.00001; I2 = 92%), and a significant overall effect (Z = 4.72, P < 0.00001). ACE inhibitors also showed a beneficial role, but with less heterogeneity (Tau2 = 0.02; Chi2 = 1.09, df = 1, P = 0.30; I2 = 8%) and a nonsignificant overall effect (Z = 1.36, P = 0.17), 95% CI (-0.24, 1.31). Conclusions: The study highlights the efficacy of carvedilol in improving LVEF in NIDCM patients over ACE inhibitors, recommends beta-blockers as first-line therapy, and advocates further research on ACE inhibitors.

Efficacy and Complication Profiles of Left Ventricular Assist Devices in Adult Heart Failure Management: A Systematic Review and Meta-Analysis.

Left ventricular assist devices (LVADs) have marked a milestone in the evolution of treatment for patients with end-stage heart failure. Their popularity and use are steadily rising. This systematic review and meta-analysis aimed to evaluate the effectiveness of LVADs in improving the survival rate of patients with end-stage heart failure and to identify the complications or adverse events associated with LVAD use. Articles for this systematic review and meta-analysis were sourced from PubMed, Google Scholar, and the Cochrane Library databases. Only studies that met the predefined PICOS eligibility criteria were analyzed. LVADs significantly improved the 6, 12, 18, and 24-month survival rates in patients with end-stage heart failure compared to no LVAD or other therapies: OR 1.87 (95%CI [1.27-2.76]), OR 2.29 (95%CI [1.61-3.26]), OR 2.07 (95%CI [0.61-6.61]), and OR 1.73 (95%CI [0.88-3.41]) for 6, 12, 18, and 24 months, respectively. The incidence of adverse events was significantly higher in the LVAD group than in the non-LVAD treatments: bleeding OR 12.53 (95%CI [2.60-60.41]), infections OR 4.15 (95%CI [1.19-14.45]), stroke OR 2.58 (95%CI [1.38-4.82]), and arrhythmia OR 2.81 (95%CI [1.64-4.80]). Overall, complications were higher in the LVAD group compared to those without LVAD treatment. Hospital readmissions due to adverse events were significantly more frequent in the LVAD group, OR 2.98 (95%CI [1.38-6.43]). Despite the elevated risk of adverse events associated with LVADs, these devices have demonstrated a notable enhancement in the survival outcomes for patients with end-stage heart failure.

Efficacy and safety of two whole IgG polyvalent antivenoms, refined by caprylic acid fractionation with or without beta-propiolactone, in the treatment of Bothrops asper bites in Colombia.

The efficacy and safety of two whole IgG polyvalent antivenoms (A and B) were compared in a randomised, blinded clinical trial in 67 patients systemically envenomed by Bothrops asper in Colombia. Both antivenoms were fractionated by caprylic acid precipitation and had similar neutralising potencies, protein concentrations and aggregate contents. Antivenom B was additionally treated with beta-propiolactone to lower its anticomplementary activity. Analysing all treatment regimens together, there were no significant differences between the two antivenoms (A=34 patients; B=33 patients) in the time taken to reverse venom-induced bleeding and coagulopathy, to restore physiological fibrinogen concentrations and to clear serum venom antigenaemia. Blood coagulability was restored within 6-24 h in 97% of patients, all of whom had normal coagulation and plasma fibrinogen levels 48 h after the start of antivenom treatment. Two patients (3.0%) had recurrent coagulopathy and eight patients suffered recurrence of antigenaemia within 72 h of treatment. None of the dosage regimens of either antivenom used guaranteed resolution of venom-induced coagulopathy within 6 h, nor did they prevent recurrences. A further dose of antivenom at 6 h also did not guarantee resolution of coagulopathy within 12-24 h in all patients. The incidence of early adverse reactions (all mild) was similar for both antivenoms (15% and 24%; P>0.05).

Aislamiento del polimorfonuclear neutrófilo de saliva por técnica de enjuague oral / Isolation of salivary polymorphonuclear neutrophil using an oral rinse technique

PROPOSITO: estandarizar una técnica sencilla y útil para el aislamiento del polimorfonuclear (PMN) neutrófilo de saliva. METODOS: el tipo de estudio fue descriptivo correlacional, con diseño no experimental. Se seleccionaron 20 pacientes, periodontalmente sanos, que no hubieran recibido terapia antibiótica durante los últimos 6 meses, que no tuvieran aparatología ortodóntica, ni resfriados al momento de la realización de la prueba. A cada individuo se le realizó un sondaje para determinar su estado periodontal; se enjuagaba la boca con agua destilada y, luego de una hora se enjuagaba 5 veces con solución de Hanks libre de calcio y magnesio con bicarbonato al 2.2g/lt y gelatina al 0.1/100 la solución recolectada se centrifugó a 1600 r.m.p. por 5 minutos. El botón obtenido se resuspendió en 30 ml de solución de Años, parecer centrifugado nuevamente; finalmente, el botón celular se suspendió en 1ml de la solución de Hanks. A partir de esta suspensión, se realizaron las pruebas de porcentaje de viabilidad y pureza y conteo celular. RESULTADOS: utilizando estadísticas descriptivas para el análisis de los datos, se encontró un número promedio de células aisladas de 6.962.000 células ml, con un porcentaje promedio de viabilidad del 93.33/100 y de pureza del 83.41/100. CONCLUSIONES: estos resultados sugieren que la técnica de aislamiento de PMN neutrófilos es efectiva, ya que proporciona un número adecuado de células, con porcentajes altos de viabilidad y pureza, para ser utilizadas en pruebas de laboratorio.

Efecto de la cocaína y las catecolaminas sobre la quimiotaxis y la quimioluminiscencia de neutrófilos humanos in vitro

El objetivo fue determinar el efecto de la cocaína sola y mezclada con catecolaminas sobre la quimiotaxis y la explosión metabólica de los neutrófilos humanos y evaluar si la cocaína se une a estas células. La quimiotaxis se realizó en un gel de agarosa utilizando el péptido quimiotáctico FMLP. La explosión respiratoria se determino mediante la cuantificación de fotones (quimioluminiscencia) emitidos por las celulas activadas con PMA. Para cada prueba, las celulas se expusieron a concentraciones de cocaína de 1 a 1000ug/m y de catecolaminas 0.001 y 0.001 ug/mL y luego a la mezcla de 1000 ug/mL de cocaina con 0.001 ug/mL de catecolamina. La union de la cocaina a las celulas se evaluó mediante un ensayo de competición, con cocaína tritiada 10 nM y cocaína no radioactiva 500 uM. Los resultados no mostraron efecto de la cocaína quimiotaxis, pero sí aumento estadisticamente significativo (p=0.004), de la quimioluminiscencia de los neutrófilos tratados con 1000ug/mL de cocaína. Los valores de quimioluminiscencia sin cocaína fueron 1.2 x 10 a la 6 ñ 10 a la 4 cuentas por minuto (cpm) y con cocaina 1.7 x 10 a la 6 ñ1 x 10 a la 5 cpm. Las catecolaminas no modificaron los resultados obtenidos con la cocaina sola. La union de la cocaína tritiada a los neutrofilos tuvo un valor de 3.893 ñ 343 cpm, que disminuyó significativamente a 301 ñ 124 cpm en el ensayo de competición (p=0.008). Se demostró un incremento en la actividad metabólica de los neutrofilos inducido por cocaína, al parecer por su union a estas celulas. Estos resultados no son extrapolables a la clínica; sin embargo, el aumento de quimioluminiscencia debe ser tenido en cuenta, puesto que la exposición recurrente a la cocaína podría eventualmente conducir al mismo efecto