• Users Online: 43
  • Print this page
  • Email this page


 
 
Table of Contents
JOURNAL SCAN
Year : 2019  |  Volume : 8  |  Issue : 1  |  Page : 44-45

Journal scan


Provenance and Peer Review Commissioned;Internally Peer Reviewed

Date of Web Publication6-Nov-2019

Correspondence Address:
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCSR.JCSR_32_19

Rights and Permissions

How to cite this article:
Suresh V, Bitla A R. Journal scan. J Clin Sci Res 2019;8:44-5

How to cite this URL:
Suresh V, Bitla A R. Journal scan. J Clin Sci Res [serial online] 2019 [cited 2019 Nov 19];8:44-5. Available from: http://www.jcsr.co.in/text.asp?2019/8/1/44/270388



PIONEER-HF Investigators: Angiotensin–neprilysin inhibition in acute decompensated heart failure

The authors studied 881 patients who were admitted for acute decompensated heart failure with an ejection fraction <40%, at 129 sites in the United States. After initial stabilisation, patients were randomised to receive sacubitril–valsartan (target dose, 97 mg of sacubitril with 103 mg of valsartan twice daily; n = 440) or enalapril (target dose, 10 mg twice daily; n = 441).

The time-averaged reduction in the N-terminal proB-type natriuretic peptide (NT-proBNP) concentration was more in the sacubitril–valsartan group than in the enalapril group; the ratio of the geometric mean of values obtained at weeks 4 and 8 to the baseline value was 0.53 in the sacubitril–valsartan group as compared with 0.75 in the enalapril group (per cent change, −46.7% vs. −25.3%; ratio of change with sacubitril–valsartan vs. enalapril, 0.71; 95% confidence interval [CI], 0.63–0.81; P < 0.001). The difference between the two groups in extent of the reduction of NT-proBNP was evident from the 1st week of onset of therapy itself. The adverse effects did not differ significantly between the two groups.


  Comment Top


Neprilysin is a membrane-bound metalloprotein endopeptidase that cleaves a wide variety of active mediators including bradykinin and substance P. Sacubitril is an inhibitor of neprilysin that raises the levels of bradykinin, that is, a potent vasodilator. The combination of sacubitril and valsartan (an angiotensin type 2 receptor blocker) has already been tested in comparison to enalapril (an angiotensin-converting-enzyme inhibitor) in chronic heart failure and found to be more effective in the PARADIGM-HF trial. The present trial shows that the benefit of blocking two pathways (angiotensin pathway and bradykinin degradation pathways) over blocking angiotensin II synthesis extends to acute heart failure also with no additional side effects.

Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K, et al. Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med 2019;380:539-48.

Adiposity and risk of decline in glomerular filtration rate: Meta-analysis of individual participant data in a global consortium

In this meta-analysis, data of 39 population cohorts were pooled to assess the rate of decline of glomerular filtration rate (GFR) in relation to the body mass index (BMI). The hazard ratios for the primary outcome (>40% decline in GFR, initiation of renal replacement therapy or an estimated GFR ≤ 10 ml/min/1.73 m2) increased with an increasing BMI even after adjusting for age, race, gender, smoking, blood pressure, diabetes, cholesterol and history of cardiovascular disease. Compared with a BMI of 25, adjusted hazard ratios for BMIs 30, 35 and 40 were 1.03, 1.28 and 1.46, respectively, over a mean follow-up of 8 years.


  Comment Top


This study shows that obesity has an adverse impact on chronic kidney disease (CKD) progression even after accounting for confounding variables. Further studies are needed to identify the mechanism as well as to determine whether a weight loss program can retard the decline in GFR in early stages of CKD.

Chang AR, Grams ME, Ballew SH, Bilo H, Correa A, Evans M, et al. Adiposity and risk of decline in glomerular filtration rate: Meta-analysis of individual participant data in a global consortium. BMJ 2019;364:k5301.

Multicentre, open-label, randomized, comparative, parallel-group, active-controlled, Phase III clinical trial to evaluate safety and efficacy of arbekacin sulphate injection versus vancomycin injection in patients diagnosed with methicillin-resistant Staphylococcus aureus infection

In this study, the authors randomised 162 patients harbouring methicillin-resistant Staphylococcus aureus (MRSA) to receive either arbekacin sulphate 200 mg OD or vancomycin 1000 mg BD for 7–14 days. The most common infections were skin and soft-tissue infections followed by community-acquired pneumonia. Overall cure rates were equal in both arms (97.53% for arbekacin and 100% for vancomycin). Adverse effects were comparable between the two groups.


  Comment Top


Drug-resistant bacteria are constantly emerging in the context of the wide use of antibiotics, often even when not indicated. Among these deadly organisms, MRSA has established itself in most hospital environments and is posing a major challenge to the safe delivery of healthcare. Arbekacin is a semisynthetic aminoglycoside antibiotic that is resistant to inactivating enzymes produced by aminoglycoside-resistant bacteria including staphylococci. It is a welcome addition to our armamentarium against MRSA.

Dube A, Deb AK, Das C, Padhye D, Bhalla H, Basu I, et al. Multicentre, open label, randomized, comparative, parallel group, active-controlled, phase III clinical trial to evaluate safety and efficacy of arbekacin sulphate injection versus vancomycin injection in patients diagnosed with MRSA infection. J Assoc Phys India 2018;66:47-50.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Comment
Comment
Comment

 Article Access Statistics
    Viewed13    
    Printed0    
    Emailed0    
    PDF Downloaded1    
    Comments [Add]    

Recommend this journal