Year : 2020 | Volume
: 9 | Issue : 1 | Page : 53--54
V Suresh, AR Bitla
Provenance and Peer Review Commissioned; Internally Peer Reviewed
|How to cite this article:|
Suresh V, Bitla A R. Journal scan.J Clin Sci Res 2020;9:53-54
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Suresh V, Bitla A R. Journal scan. J Clin Sci Res [serial online] 2020 [cited 2020 Aug 8 ];9:53-54
Available from: http://www.jcsr.co.in/text.asp?2020/9/1/53/285715
Kang DH, Park SJ, Lee SA, Lee S, Kim DH, Kim HK, et al. Early surgery or conservative care for asymptomatic aortic stenosis. N Engl J Med 2020;382:111-9. Suresh and Bitla: Journal Scan.
The approach to asymptomatic patients with severe aortic stenosis has remained controversial. The authors randomised 145 asymptomatic patients with very severe aortic stenosis to either early surgery (n = 72) while still asymptomatic or to conservative treatment (n = 73). No surgery-related mortality was reported in the early surgery patients. Death from cardiovascular causes over the follow-up period was only 1% in the early surgery-treated group as against 15% in the non-surgically managed group. Even all-cause mortality in the early operated group was only one-third of that in the conservatively treated group. Hospitalisation for heart failure was also less frequent in patients undergoing early surgery.
There is no controversy on the need for surgery in symptomatic patients with aortic valve stenosis. However, the management of asymptomatic but severe aortic valve stenosis remains controversial, and definite opinion on early surgery versus conservative treatment has to be informed by the publication of outcome-based randomised trials. The present trial shows that at least in very severe aortic stenosis, asymptomatic patients fare better when subjected to surgery.
Yu Y, Arah OA, Liew Z, Cnattingius S, Olsen J, Sørensen HT, et al. Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: Population based cohort study with 40 years of follow-up. BMJ 2019;367:l6398.
This study attempts to address the question, whether children of diabetic mothers who had pre-gestational or gestational diabetes had earlier cardiovascular disease than those children who were born to women without diabetes during their pregnancy.
The data on maternal diabetes were population based and collected from Danish health registries. Among 2,432,000 children born between 1977 and 2016 without congenital heart disease, 22,055 were born to mothers with type 1 diabetes mellitus, 6531 to mothers with type 2 diabetes mellitus and 26,272 to mothers having gestational diabetes.
During follow-up from birth onwards, children of women with diabetes had a 29% increased overall rate of early-onset cardiovascular disease than those born to non-diabetic women. The authors also observed increased risks for early-onset heart failure, hypertensive disease, deep vein thrombosis and pulmonary embolism in the offspring of diabetic mothers.
It is increasingly realised that many diseases occurring in adulthood may have their foundations laid during the foetal period itself, as a consequence of an adverse intrauterine environment. Thus, the present study shows that children born to mothers with diabetes during the index pregnancy had an earlier onset of cardiovascular disease. Whether tight control of maternal diabetes will ameliorate this risk to the offspring has to be determined and should form the focus of longitudinal studies in the future.
Mohan V, Ramu M, Poongothai S, Kasthuri S. A ProspectIve, OpeN-Label, Randomized Study Comparing EffIcacy and Safety of Teneligliptin VErsus Sitagliptin in Indian Patients with Inadequately Controlled Type 2 Diabetes Mellitus: INSITES Study. J Assoc Physicians India 2019;67:14-9.
There have been no previous head-to-head comparisons between teneligliptin and sitagliptin, two widely used dipeptidyl peptidase inhibitors in India.
In this study, the authors randomised 76 patients with type 2 diabetes mellitus to receive either 20 mg teneligliptin or 100 mg sitagliptin as an add-on to metformin or sulfonylurea in patients not controlled on the above agents. At 12 weeks, reductions in glycated haemoglobin (HbA1c), fasting plasma glucose and postprandial plasma glucose were comparable between the two groups. Achievement of HbA1c reduction to <7% was more often observed in teneligliptin arm rather than sitagliptin arm (33.3% vs. 19.4%). There were no differences in the adverse events.
Teneligliptin, which has not been approved for the treatment of diabetes by the United States Federal Drug Authority, is actually a much cheaper alternative to the Food and Drug Administration -approved molecule sitagliptin. However, the present study, which is a head-to-head comparison between the two, suggests that the two are equally efficacious and have a similar incidence of adverse effects. This should reassure physicians intending to prescribe teneligliptin to patients who cannot afford other costlier dipeptidyl peptidase-IV inhibitors.
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