Comparison of effects of nebivolol, carvedilol and irbesartan on left ventricular hypertrophy associated with hypertension.

OBJECTIVES: The aim of this study was to investigate if the new generation beta-blockers are as effective as irbesartan, which is an angiotensin receptor blocker (ARB), on left ventricular hypertrophy (LVH). PATIENTS AND METHODS: The study included 85 patients (average age: 56.6±9.6 year) with stage 1 and 2 hypertension, who previously didn't receive an antihypertensive treatment, but diagnosed with LVH echocardiographically. The patients were divided into three different treatment groups: irbesartan (n=28), nebivolol (n=25) and carvedilol (n=32). The patients were reassessed clinically and echocardiographically at 3, 6 and 12 months after the treatments. RESULTS: There was no statistically significant difference in baseline left ventricular mass index (LVMI) and other parameters among the three treatment groups (p > 0.05). Although there was no significant decrease in LVMI in irbesartan and carvedilol groups at 3 months after the treatment (p > 0.05), the values measured at 6 and 12 months (p < 0.0001) were significant. The decrease in LVMI in the nebivolol group was significant at 3, 6 and 12 months (p < 0.0001). There was a significant difference in measurements at 12 months (p < 0.05). CONCLUSIONS: Both of the new generation beta-blockers were more effective than irbesartan in the regression of LVH. A significant regression in LVH was observed 3 months after nebivolol treatment and 6 months after irbesartan and carvedilol treatments.

Wildflower (Hyoscyamus reticulatus) causes QT prolongation.

INTRODUCTION: In the environment, there are hundreds of poisonous and injurious plants with a wide variety of toxicity. Among all plants with anticholinergic effect, Hyoscyamus reticulatus is a species whose clinicopathological effects have been poorly described in literature. The paper is especially aimed at drawing attention to the possibly fatal syndrome of prolonged QT, as well as to clinical and laboratory changes in six members of a single family poisoned with this plant. CASES: Six female patients aged from 19 to 49 presented to our emergency room with a suspicion of being poisoned after having ingested a plant known as 'the mad axe plant' (Hyoscyamus reticulatus). At least one of anticholinergic symptoms including flushing, mydriasis, dry mouth and tachycardia was present in all of the patients. In addition, different levels of agitation were observed in four of the patients. A euphoric emotional state was present in two patients. The corrected QT distances were found to be prolonged in three of the patients. DISCUSSION AND CONCLUSION: Based on economical, social and cultural reasons, it is a very common habit in our country, especially in our region in spring and summer months, to consume some plants growing spontaneously in rural areas as food. Intoxication with Hyoscyamus reticulatus is a plant poisoning that is poorly described in literature. Its classical symptoms are predominantly anticholinergic. Although it is commonly self-limited and can be corrected with close observation and supportive treatments, it should be kept in mind that the prolongation of QT interval can accompany the symptoms of poisoning with this plant (Tab. 1, Fig. 3, Ref. 19).

Acute myocardial infarction during the early postpartum period successfully treated with tirofiban.

Acute myocardial infarction (AMI) during the early postpartum period is rare but may be associated with poor maternal outcome. We report an inferior AMI in 30-year-old woman with mitral valve replacement during early postpartum period successfully treated with tirofiban. For a patient that has got AMI due to massive thrombus and that is not suitable for percutaneous coronary intervention and has got contraindication to thrombolytic therapy, glikoprotein IIb-IIIa inhibitor (tirofiban) infusion must be kept in mind.

The role of oxidative stress in diabetic cardiomyopathy: an experimental study.

BACKGROUND: Diabetes mellitus (DM) has a negative effect on cardiovascular functions. Little, however, is known of the overall effect of DM on the cardiac histology or the pathophysiological basis of this. AIM: We aimed to investigate the role of oxidative stress on the pathogenesis of diabetic cardiomyopathy in an experimental model. MATERIALS AND METHODS: 12 week-old female Sprague Dawley rats were randomly allocated into a healthy control group (n=6) and an DM group (n=6). After 12 weeks of alloxan induced DM, the groups' cardiac tissues were histopathologically analyzed and examined for determination of oxidant and antioxidant enzymes [activities of catalase (CAT), superoxide dismutase (SOD), and myeloperoxidase (MPO) and amount of reduced glutathione (GSH) and lipid peroxidation (LPO)]. RESULTS: When compared to the control group, the DM group showed cardiomyopathic changes. In the DM group, activities of CAT (144 +/- 0.9 vs. 112 +/- 1.4, p < 0.05) and LPO amount (27.0 +/- 0.74 vs. 14.4 +/- 0, 20, p < 0.05) were significantly increased whereas activities of SOD (142 +/- 0.2 vs. 146 +/- 0.7, p < 0.05) and amount of GSH (3.48 +/- 0.01 vs. 3.73 +/- 0.01, p < 0.05) were significantly decreased when compared to the control group. Besides, activities of MPO (7.3 +/- 0.02 vs. 8.6 +/- 0.11, p < 0.05) were comparable between groups. CONCLUSIONS: Using the experimental animal model, we were able to demonstrate that DM causes cardiomyopathic changes, and we propose that these changes could be mediated by an oxidative stress.

Seasonal changes in antioxidant defence system of liver and gills of Salmo trutta caspius, Salmo trutta labrax and Salmo trutta macrostigma.

Seasonal changes in antioxidant enzyme activities (superoxide dismutase, SOD, EC 1.15.1.1; catalase, CAT, EC 1.11.1.16; glutathione peroxidase, GPx, EC 1.11.1.9; glutathione reductase, GR, EC 1.6.4.2; glucose-6-phosphate dehydrogenase, G6PD, EC 1.1.1.49 and glutathione S-transferase, GST, EC 1.5.1.18) and lipid peroxidation (LPO) levels of livers and gills of female Caspian trout Salmo trutta caspius, Black Sea trout Salmo trutta labrax and mountain trout Salmo trutta macrostigma were investigated. SOD, CAT, GPx, G6PD and GST activities were higher in liver compared to gills of all sub-species; concomitantly, the GR activity was also higher in the livers of S. t. caspius and S. t. labrax, but the reverse was seen in S. t. macrostigma. LPO levels were higher in the gills compared to the liver of all sub-species. There was no general trend in the seasonal changes in the gill antioxidant enzyme (AE) activities or LPO levels. Higher AE activities, however, were found in the liver of each sub-species during autumn, and this coincided with an increase in the gonado-somatic index.

Effect of sedation on soluble P-selectin levels, coagulation and myocardial damage following a coronary intervention.

This study was aimed to investigate the effect of sedation on plasma soluble P-selectin (sP-selectin) levels and initiation phase of coagulation following coronary intervention. A total of 58 patients with unstable angina were randomised into two groups of sedated (n = 29) and nonsedated (n = 29) patients. sP-Selectin, adrenaline, noradrenaline, von Willebrand factor (vWF), fibrinogen, platelet and troponin-I levels were measured before the intervention and at 30 min and 24 h after the intervention. In the sedated group, adrenaline, noradrenaline, sP-selectin and fibrinogen levels remained stable 30 min after the intervention (p > 0.05), whereas vWF level increased (p < 0.05). In the nonsedated group, 30-min sP-selectin (p < 0.001), adrenaline (p < 0.05), noradrenaline (p = 0.012), vWF (p < 0.001) and fibrinogen (p < 0.001) levels were found to be increased. Also, 24-h sP-selectin, vWF and fibrinogen levels for both groups showed significant increases when compared with the values both 30 h before (p < 0.001) and 30 min after the intervention (p < 0.001). Sedation before interventions reduces sP-selectin levels, initial phase of coagulation and, consequently, myocardial damage.