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Alejandro Gabriel G Gonzalez Garay, Daniel Molano Franco, Víctor H Nieto Estrada, Arturo J Martí-Carvajal, Ingrid Arevalo-Rodriguez
BACKGROUND: High altitude illness (HAI) is a term used to describe a group of mainly cerebral and pulmonary syndromes that can occur during travel to elevations above 2500 metres (˜ 8200 feet). Acute mountain sickness (AMS), high altitude cerebral oedema (HACE) and high altitude pulmonary oedema (HAPE) are reported as potential medical problems associated with high altitude ascent. In this second review, in a series of three about preventive strategies for HAI, we assessed the effectiveness of five of the less commonly used classes of pharmacological interventions...
March 12, 2018: Cochrane Database of Systematic Reviews
George Bazoukis, Costas Thomopoulos, Gary Tse, Costas Tsioufis
Although mineralocorticoid antagonists (MRAs) have been proposed as effective fourth-line blood pressure (BP) lowering agents in resistant hypertension, this effect in heart failure is undetermined. In this synthesis of heart failure randomized controlled trials (RCTs), we evaluated the extent of BP lowering following MRA treatment against placebo. We searched Medline and the Cochrane Collaboration Library databases from 1991 to September 2016 for RCTs, in which MRAs were compared with placebo. The quality of RCTs was assessed with Cochrane risk of bias tool...
March 12, 2018: Heart Failure Reviews
Patricia Barrionuevo, Mohammed Nabhan, Osama Altayar, Zhen Wang, Patricia J Erwin, Noor Asi, Kathryn A Martin, M Hassan Murad
Background: Several pharmacologic treatments for hirsutism are used in practice; however, their relative efficacy is unclear. Methods: We searched MEDLINE, EMBASE, and CENTRAL through January 2017 for randomized controlled trials (RCTs) with follow-up of at least 6 months that evaluated antiandrogens, insulin sensitizers, and oral contraceptives in women with hirsutism. Independent pairs of reviewers selected and appraised trials. Random-effects network meta-analysis was used to compare individual drugs and classes...
March 7, 2018: Journal of Clinical Endocrinology and Metabolism
Mohammed Benadallah, Oualid Talhi, Fatiha Nouali, Nourredine Choukchou-Braham, Khaldoun Bachari, Artur M S Silva
The present review deals with the progress in medicinal chemistry of spirocyclic compounds, a wider class of natural and synthetic organic molecules, defined as a hybrid of two molecular entities covalently linked via a unique tetrahedral carbon. This spiro central carbon confers to the molecules a tridimensional structurally oriented framework, which is found in many medicinally relevant compounds, a well-known example is the anti-hypertensive spironolactone. Various bioactive natural products possess the privileged spiro linkage and different chemo-types thereof become synthetically accessible since the 20th century...
March 9, 2018: Current Medicinal Chemistry
Muthiah Vaduganathan, Brian L Claggett, Neal A Chatterjee, Inder S Anand, Nancy K Sweitzer, James C Fang, Eileen O'Meara, Sanjiv J Shah, Sheila M Hegde, Akshay S Desai, Eldrin F Lewis, Jean Rouleau, Bertram Pitt, Marc A Pfeffer, Scott D Solomon
BACKGROUND: Sudden death (SD) may be an important mode of death in heart failure with preserved ejection fraction (HFpEF). OBJECTIVES: To investigate rates and predictors of SD or aborted cardiac arrest (ACA) in HFpEF. METHODS: We studied 1,767 patients with HFpEF (EF≥45%) enrolled in the Americas region of the TOPCAT trial. We identified independent predictors of composite SD/ACA with step-wise backward selection using competing risks regression analysis accounting for non-sudden causes of death...
March 4, 2018: JACC. Heart Failure
Milton Packer
Among patients with heart failure and a preserved ejection (HFpEF), obesity is associated with a distinct phenotype that is characterized by adiposity-driven plasma volume expansion and cardiac overfilling, which is coupled with an impairment of ventricular distensibility. These pathophysiological abnormalities may be related to the increased actions of specific adipocyte-derived signalling molecules (aldosterone, neprilysin and leptin) that work in concert with increased renal sympathetic nerve traffic and activated beta2 -adrenergic receptors to promote sodium retention, microvascular rarefaction, cardiac fibrosis and systemic inflammation...
March 1, 2018: European Journal of Heart Failure
Charlotte Boughton, David Taylor, Lea Ghataore, Norman Taylor, Benjamin C Whitelaw
We describe severe hypokalaemia and hypertension due to a mineralocorticoid effect in a patient with myelodysplastic syndrome taking posaconazole as antifungal prophylaxis. Two distinct mechanisms due to posaconazole are identified: inhibition of 11β hydroxylase leading to the accumulation of the mineralocorticoid hormone 11-deoxycorticosterone (DOC) and secondly, inhibition of 11β hydroxysteroid dehydrogenase type 2 (11βHSD2), as demonstrated by an elevated serum cortisol-to-cortisone ratio. The effects were ameliorated by spironolactone...
2018: Endocrinology, Diabetes & Metabolism Case Reports
Ashley K Clark, Rebecca L Quinonez, Suzana Saric, Raja K Sivamani
Hidradenitis suppurativa is a recurrent inflammatory skin condition characterized by abscesses and boils, predominantly in the groin, armpit, and buttocks areas. HS is not a life-threatening condition, but severely impairs quality of life in those affected. Finding a successful treatment approach for HS has been challenging, in part because of the lack of a gold-standard treatment method, limited research-based information, and the nature of clinical variation in the disease. Treatment commonly consists of antibiotics, anti-inflammatory therapy, hormonal therapy, and more invasive clinical procedures...
November 12, 2017: Dermatology Online Journal
Yuwen Wang, Yi Xu, Runmei Zou, Lijia Wu, Ping Liu, Hong Yang, Zhenwu Xie, Cheng Wang
BACKGROUND: The effect of levocarnitine supplementation has not been evaluated in children with dilated cardiomyopathy (DCM). OBJECTIVE: The aim of this study was to explore the effect of oral levocarnitine supplementation in pediatric patients with DCM. METHODS: Twenty-nine children with DCM (17 male, 12 female, aged 1 month to 13 years) were divided into two groups according to a simple randomization: control group (n = 10) and experimental group (n = 19)...
February 21, 2018: Paediatric Drugs
Eduardo M Krieger, Luciano F Drager, Dante M A Giorgi, Alexandre C Pereira, José Augusto Soares Barreto-Filho, Armando R Nogueira, José Geraldo Mill, Paulo A Lotufo, Celso Amodeo, Marcelo C Batista, Luiz C Bodanese, Antônio C C Carvalho, Iran Castro, Hilton Chaves, Eduardo A S Costa, Gilson S Feitosa, Roberto J S Franco, Flávio D Fuchs, Armênio C Guimarães, Paulo C Jardim, Carlos A Machado, Maria E Magalhães, Décio Mion, Raimundo M Nascimento, Fernando Nobre, Antônio C Nóbrega, Antônio L P Ribeiro, Carlos R Rodrigues-Sobrinho, Antônio F Sanjuliani, Maria do Carmo B Teixeira, Jose E Krieger
The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring...
February 20, 2018: Hypertension
P Rossignol, L Juillard
Hypertension is common in patients with chronic renal disease particularly those with diabetes. It is sometimes resistant to the pharmacological treatment. The mineralocorticoid receptor antagonist spironolactone may be indicated here. The mineralocorticoid receptor antagonists have a Class 1, Level A indication for the treatment of heart failure with reduced ejection fraction. There is an associated risk of worsening renal function and of hyperkalemia which does not hinder their clinical benefit. However, an appropriate biological monitoring is warranted, along with potential dose adaptations...
June 2017: Néphrologie & Thérapeutique
Frederick-Anthony Farrugia, Nicolaos Zavras, Georgios Martikos, Panagiotis Tzanetis, Anestis Charalampopoulos, Evangelos P Misiakos, Dimitrios Sotiropoulos, Nikolaos Koliakos
OBJECTIVES: The aim of this study was to present up to date information concerning the diagnosis and treatment of primary aldosteronism (PA). PA is the most common cause of endocrine hypertension. It has been reported up to 24% of selective referred hypertensive patients. METHODS: We did a search in Pub-Med and Google Scholar using the terms: PA, hyperaldosteronism, idiopathic adrenal hyperplasia, diagnosis of PA, mineralocorticoid receptor antagonists, adrenalectomy, and surgery...
January 1, 2018: Endocrine Regulations
Lindsey R Sangaralingham, S Jeson Sangaralingham, Nilay D Shah, Xiaoxi Yao, Shannon M Dunlay
BACKGROUND: The US Food and Drug Administration approved the use of sacubitril/valsartan in patients with heart failure with reduced ejection fraction in July 2015. We aimed to assess the adoption and prescription drug costs of sacubitril/valsartan in its first 18 months after Food and Drug Administration approval. METHODS AND RESULTS: Using a large US insurance database, we identified privately insured and Medicare Advantage beneficiaries who filled a first prescription for sacubitril/valsartan between July 1, 2015, and December 31, 2016...
February 2018: Circulation. Heart Failure
Ruth Morgan, John Keen, Daniel Halligan, Alan O'Callaghan, Ruth Andrew, Dawn Livingstone, Amber Abernethie, Giorgia Maltese, Brian Walker, Patrick Hadoke
Glucocorticoids are potent inhibitors of angiogenesis in the rodent in vivo and in vitro but the mechanism by which this occurs has not been determined. Administration of glucocorticoids is used to treat a number of conditions in horses but the angiogenic response of equine vessels to glucocorticoids and, therefore, the potential role of glucocorticoids in pathogenesis and treatment of equine disease, is unknown. This study addressed the hypothesis that glucocorticoids would be angiostatic both in equine and murine blood vessels...
2018: PloS One
Marco A Rocha, Ediléia Bagatin
Acne is a multifactorial and inflammatory disease of pilosebaceous follicles, which affects most adolescents. Recent epidemiological data revealed a difference in adults affected by this disease. Women have a high prevalence and incidence when compared with men, especially after 25 years of age. In contrast to what was initially thought, most of these patients do not present endocrinopathy capable of leading to the development of the lesions. When present, polycystic ovarian syndrome is the main cause. However, in these cases, acne is rarely the only dermatological manifestation; hirsutism and acanthosis nigricans are often present...
2018: Clinical, Cosmetic and Investigational Dermatology
Elizabeth Crellin, Kathryn E Mansfield, Clémence Leyrat, Dorothea Nitsch, Ian J Douglas, Adrian Root, Elizabeth Williamson, Liam Smeeth, Laurie A Tomlinson
OBJECTIVE: To determine if trimethoprim use for urinary tract infection (UTI) is associated with an increased risk of acute kidney injury, hyperkalaemia, or sudden death in the general population. DESIGN: Cohort study. SETTING: UK electronic primary care records from practices contributing to the Clinical Practice Research Datalink linked to the Hospital Episode Statistics database. PARTICIPANTS: Adults aged 65 and over with a prescription for trimethoprim, amoxicillin, cefalexin, ciprofloxacin, or nitrofurantoin prescribed up to three days after a primary care diagnosis of UTI between April 1997 and September 2015...
February 9, 2018: BMJ: British Medical Journal
Vladimir A Kashkin, Elena V Shekunova, Alexei Y Egorov, Alexei Bagrov
BACKGROUND AND OBJECTIVE: Previously it was demonstrated that digitalis-like cardiotonic steroid, marinobufagenin (MBG), is implicated in the development of ethanol addiction in rats. We hypothesized that (i) levels of sodium pump ligand, MBG, would be negatively correlated with amount of ethanol consumed by rats, and (ii) that spironolactone would oppose the MBG induced ethanol-seeking behavior and blood pressure in rats. METHODS: Voluntary consumption of 9% alcohol (vs...
February 11, 2018: Current Hypertension Reviews
Caleb K Y Yip, Sumit Bansal, Siew Ying Wong, Aik Jiang Lau
Galeterone and abiraterone acetate are anti-androgens developed for the treatment of metastatic castration-resistant prostate cancer. In the present study, we investigated the effect of these drugs on dehydroepiandrosterone (DHEA) sulfonation catalyzed by human liver and intestinal cytosols and human recombinant sulfotransferase enzymes (SULT2A1, SULT2B1b, and SULT2E1), and compared their effects to those of other anti-androgens (cyproterone acetate, spironolactone, and danazol). Each of these chemicals (10 μM) inhibited DHEA sulfonation catalyzed by human liver and intestinal cytosols...
February 7, 2018: Drug Metabolism and Disposition: the Biological Fate of Chemicals
Ansha Subramanian, Mangaiarkkarasi Adhimoolam, Suresh Kannan
Aim: Drug-drug interactions (DDIs) are one of the major but preventable cause of adverse drug reaction. Study of prevalence and prediction of DDIs will make the physician easier to provide better patient care and mitigate patient's harm. Hence, the study was planned to evaluate the potential DDIs among medication prescribed to hypertensive patients in our hospital. Materials and Methods: A prospective, cross-sectional study was conducted among the hypertensive patients in medicine (outpatient/inpatient) department over the period of three months in a tertiary care hospital...
January 2018: Perspectives in Clinical Research
Kanako Yamamoto, Takashi Yamamoto, Masayuki Takamura, Soichiro Usui, Hisayoshi Murai, Shuichi Kaneko, Takumi Taniguchi
AIM: To evaluate the effects of mineralocorticoid receptor (MR) antagonists on mortality and inflammatory responses after hemorrhagic shock (HS) in rats. METHODS: One hundred and two male Sprague-Dawley rats were randomly assigned to one of the following three groups: Control, spironolactone (SPL), and eplerenone (EP) groups. HS was induced by the removal of blood. One half of rats were evaluated to determine mortality, hemodynamics, plasma tumor necrosis factor-alpha (TNF-α) concentrations, and arterial blood gas at 8 h after HS recovery...
February 4, 2018: World Journal of Critical Care Medicine
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