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Pressures do not equal volumes: implications for heart failure management in patients with CardioMEMS.

Pulmonary arterial pressures are often used as surrogates for intravascular blood volume. However, the relationship between pressure and volume remains controversial. To contextualize and provide concrete examples and impact on clinical management, we report two cases of heart failure (one in heart failure with reduced ejection fraction and one in heart failure with preserved ejection fraction) where pressure-based measurements did not accurately represent the intravascular status and affected clinical management.

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… She remained on fludrocortisone 0.1 mg BID for adrenal insufficiency and midodrine 5 mg TID for her low blood pressures and low‐dose HF GDMT (metoprolol succinate 25 mg daily, lisinopril 2.5 mg daily, spironolactone 12.5 mg daily). … She was taking apixaban 5 mg daily, atorvastatin 40 mg daily, empagliflozin 10 mg daily, furosemide 20 mg daily, lisinopril 10 mg daily, metoprolol succinate 25 mg daily, and spironolactone 25 mg every other day. …

Eplerenone shows renoprotective effect by reducing LOX-1-mediated adhesion molecule, PKCepsilon-MAPK-p90RSK, and Rho-kinase pathway.

Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) may play an important role in atherosclerosis by inducing leukocyte adhesion molecules, such as intercellular and vascular cell adhesion molecule-1 (intercellular adhesion molecule-1 [ICAM-1], vascular cell adhesion molecule-1 [VCAM-1]). We hypothesized that eplerenone, a novel selective aldosterone blocker, produces inhibition of LOX-1-mediated adhesion molecules, suppresses mitogen-activated protein (MAP) kinase and its downstream effector p90 ribosomal S6 kinase (p90RSK) through the protein kinase Cepsilon (PKCepsilon) pathway,

Effects of converting enzyme inhibitors on renal P-450 metabolism of arachidonic acid.

The effects of blockade of the renin-angiotensin system on the renal metabolism of arachidonic acid (AA) were examined. Male Sprague-Dawley rats were treated with vehicle, captopril (25 mg x kg(-1) x day(-1)), enalapril (10 mg x kg(-1) x day(-1)), or candesartan (1 mg x kg(-1) x day(-1)) for 1 wk. The production of 20-hydroxyeicosatetraenoic acid (20-HETE) and epoxyeicosatrienoic acids (EETs) by renal cortical microsomes increased in rats treated with captopril by 59 and 24% and by 90 and 58% in rats treated with enalapril. Captopril and enalapril increased 20-HETE production in the outer medu

Advances in the Study of Denosumab Treatment for Osteoporosis and Sarcopenia in the Chinese Middle-Aged and Elderly Population.

Osteosarcopenia (OS) is a geriatric syndrome characterized by the concurrent presence of osteoporosis and sarcopenia, predominantly affecting the elderly population. Osteoporosis (OP) is a systemic skeletal disorder characterized by decreased bone mass, compromised bone microarchitecture, and heightened bone fragility, substantially elevating fracture risk. Sarcopenia (SP) is defined by decreased muscle mass, strength, and/or functional capacity. Both conditions are age-related degenerative diseases with overlapping pathophysiological mechanisms, commonly co-occurring in elderly individuals an

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… The study conducted by Song et al 55 demonstrated that spironolactone significantly reduces the risk of osteoporosis and fractures in middle-aged and elderly hypertensive patients. … This study underscored the role of antihypertensive medications, including spironolactone, in alleviating the adverse effects of aldosterone on bone metabolism, thereby contributing to reduced bone loss. …

Medicine manipulation: An alternative to mitigate therapeutic gaps in the Brazilian Unified Health System?

Despite the various initiatives carried out in Brazil and in the world, the challenge of offering essential medicines in adequate presentations remains, especially to the public affected by diseases considered neglected and the pediatric population, for whom the therapeutic options remain limited. The main objective of this study was to evaluate the production of manipulated medicines as a strategy to mitigate therapeutic and access gaps to essential medicines within the Brazilian public health system, called the Unified Health System (SUS). The evaluation, carried out between 2020 and 2021, i

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… These are medications such as Pyridoxine (vitamin B6), Cholecalciferol, Spironolactone and Captopril, in oral solution presentations, whose unavailability causes treatment difficulties, especially in the pediatric population, including newborns ( Table 1 ). … 5 mL Oral solution | Bacterial infections; quinine or artesunate treatment supplement for multidrug treatment; P. falciparum malaria; short-term prophylaxis of multidrug-resistant P. falciparum Malaria. | Infantile Enalapril | 5 mg/mL Oral solution | Hypertension; Cardiac insufficiency. | Infantile Spironolactone …

Risk Factors and Prevention of Cancer and CVDs: A Chicken and Egg Situation.

Cardiovascular diseases and cancer are the two primary causes of mortality worldwide. Although traditionally regarded as distinct pathologies, they share numerous pathophysiological mechanisms and risk factors, including chronic inflammation, insulin resistance, obesity, and metabolic dysregulation. Notably, several cancers have been identified as closely linked to cardiovascular diseases, including lung, breast, prostate, and colorectal cancers, as well as hematological malignancies, such as leukemia and lymphoma. Additionally, renal and pancreatic cancers exhibit a significant association wi

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… Conversely, spironolactone seems linked to a diminished risk of prostatic neoplasms in males and bladder neoplasms in females [ 123 ]. … Association of spironolactone use with risk of urinary tract cancer in the general population: A matched population-based cohort study PLoS ONE 2024 19 e0300391 10.1371/journal.pone.0300391 38536840 PMC10971784 117. Numbere B. Fleming K.M. Walker A. Card T.R. …

Fanconi Syndrome in an Adult With Chronic Alcohol Use Disorder: A Rare Etiology.

Fanconi syndrome is described as a defect in the proximal tubular reabsorption of glucose, amino acids, uric acid, phosphate, and bicarbonate, falling under type 2 renal tubular acidosis (RTA). Some common causes include drugs, heavy metals, infections, and genetics (particularly mitochondrial disorders).  We present a case of a 33-year-old Caucasian female with chronic alcohol use disorder. She was treated for acute kidney injury (AKI) but had persistent hypophosphatemia, hypokalemia, hypouricemia, low bicarbonate, along with glycosuria consistent with Fanconi syndrome. An exhaustive workup r

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… She was discharged on folic acid, spironolactone, and potassium chloride. After four weeks of alcohol abstinence, she presented to the clinic with significant improvement in her symptoms. …

Risk factors for renal toxicity after inpatient cisplatin administration.

BACKGROUND: After several decades, cisplatin continues to be an essential drug for the treatment of several tumors, however, its potential nephrotoxicity is still a clinically relevant issue. Identification of predisposing factors for renal toxicity could be of value to warrant prophylactic measures. METHODS: We analyzed data from 198 patients with various tumor types, treated with cisplatin containing regimens in our regional cancer center in a two-years period. Assessed variables included age, gender, smoking status, alcohol consumption, tumor type, prior or concomitant anticancer treatment

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… Intriguingly, cirrhotic patients are frequently treated with spironolactone, a drug that increases cisplatin nephrotoxicity as previously described [ 14 ]. A high number of cisplatin cycles was previously identified as a risk factor for renal toxicity [ 15 ]. … Ahmida MH Abdel-Gayoum AA El-Fakhri MM Effect of spironolactone on cisplatin-induced nephrotoxicity in rabbits Hum Exp Toxicol 2001 20 453 459 10.1191/096032701682693026 11776407 15. …

Novel Therapeutics for Anthracycline Induced Cardiotoxicity.

Anthracyclines remain an essential component of the treatment of many hematologic and solid organ malignancies, but has important implications on cardiovascular disease. Anthracycline induced cardiotoxicity (AIC) ranges from asymptomatic LV dysfunction to highly morbid end- stage heart failure. As cancer survivorship improves, the detection and treatment of AIC becomes more crucial to improve patient outcomes. Current treatment modalities for AIC have been largely extrapolated from treatment of conventional heart failure, but developing effective therapies specific to AIC is an area of growing

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… Conversely, in Akpek et al., a placebo-controlled randomized controlled trial of spironolactone demonstrated that administration of spironolactone was protective of both systolic and diastolic cardiac function ( 27 ). … Akpek M Ozdogru I Sahin O Inanc M Dogan A Yazici C Protective effects of spironolactone against anthracycline-induced cardiomyopathy. Eur J Heart Fail. ( 2015 ) 17 : 81 – 9 . 10.1002/ejhf.196 25410653 28. Herrmann J . …

Частота и факторы риска в случае вновь диагностированной гиперкалемии после выписки из больницы пациентов, не зависящих от диализа, которые лечатся ингибиторами RAS.

ВВЕДЕНИЕ: Ингибиторы системы " ренин-ангиотенсин " (РАС) все чаще предписываются в силу их позитивного воздействия на систему " конечная организация " . Иатрогенная гиперкалемия представляет собой хорошо известное опасное для жизни осложнение использования ингибитора RAS у пациентов, страдающих хроническим заболеванием почек (CKD). Мы предположили, что у пациентов, проходящих курс лечения с помощью ингибиторов RAS, часто возникает гиперкалемия после выписки из больницы, даже если во время госпитализации у них была нормальная оклемия, так как их образ жизни существенно измен

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… Spironolactone, which is another type of RAS inhibitor, is also widely used for the reduction of mortality and morbidity in heart failure patients[ 6 ]. Despite these beneficial effects, RAS inhibitors also have a severe, life-threatening adverse effect, hyperkalemia[ 7 ][ 8 ]. … The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341: 709–17. doi: 10.1056/NEJM199909023411001 7. Acker CG, Johnson JP, Palevsky PM, Greenberg A. …

Abstracts from the 8th Drug Hypersensitivity Meeting (DHM)

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… On discharge, life-long eviction of allopurinol, amlodipine and spironolactone was recommended. … A strong positive reaction to spironolactone was observed at 48 h in all tested concentrations (0.25 mg/mL, 2.5 mg/mL, 5 mg/mL) but no reaction to allopurinol at any concentration. Conclusion Spironolactone has rarely been associated with DRESS or indeed other delayed HS reactions. …

Frailty as an Effect Modifier in Randomized Controlled Trials: A Systematic Review.

BackgroundThe effect of clinical interventions may vary by patients' frailty status. Understanding treatment effect heterogeneity by frailty could lead to frailty-guided treatment strategies and reduce overtreatment and undertreatment. This systematic review aimed to examine the effect modification by frailty in randomized controlled trials (RCTs) that evaluate pharmacological, non-pharmacological, and multicomponent interventions.MethodsWe searched PubMed, Web of Science, EMBASE, and ClinicalTrial.gov, from their inception to 8 December 2023. Two reviewers independently extracted trial data a

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… frailty index (0 to < 0.3) B: frailty index (0.3 to < 0.4) C: frailty index (0.4 to < 0.5) D: frailty index (0.5 to 1) | HF hospitalization or cardiovascular death † A: HR 0.78 (0.52, 1.16) B: HR 0.79 (0.58, 1.06) C: HR 1.00 (0.73, 1.39) D: HR 0.74 (0.51, 1.07) | There was no evidence that the effect of spironolactone … Another trial found dapagliflozin was associated with lower rates of HF hospitalization or cardiovascular death ( p -for-interaction=NR) compared with placebo in patients with frailty index <0.311, but not in patients with frailty index ≥0.311. 30 There was significant treatment effect of spironolactone …

Cardiometabolic Comorbidities in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review.

There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or chronic lymphocytic leukemia, who will receive cancer therapy for many years. Current clinical practice guidelines focus on lifestyle interventions, such as exercise and healthy eating habits, but generally do not address management strategies for clinicians or strategies to increase adherence to medications. We discuss 3 cardiometabolic comor

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… for abiraterone No specific first-line recommendation for lupron and degarelix | Spironolactone may decrease the therapeutic effect of abiraterone Flutamide | Uncommon | Prostate Nilutamide | Uncommon | Prostate Aromatase inhibitors | Anastrozole 158 | Very common | Breast | No specific considerations … Unexpected outcome (positive or negative) including adverse drug reactions: Spironolactone, a possible selective androgen receptor modulator, should be used with caution in patients with metastatic carcinoma of the prostate. BMJ Case Rep. 2012;2012 doi: 10.1136/bcr.11.2011.5238. 61. …

Prevention of cancer-therapy related cardiac dysfunction.

PURPOSE OF REVIEW: Introduction of modern cancer therapies has led to increased survival of affected patients. With this advantage, the incidence of cancer therapy-related cardiac dysfunction (CTRCD) has increased and reasonable prevention strategies become necessary. This review outlines the major approaches to limit development and progression of CTRCD. RECENT FINDINGS: A broad range of cancer therapies can provoke CTRCD ranging from mild asymptomatic forms to severe heart failure. Profound cardiological assessment of cardiovascular comorbidities before initiation of cancer therapy allows i

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… Akpek M Protective effects of spironolactone against anthracycline-induced cardiomyopathy Eur J Heart Fail 2015 17 1 81 89 10.1002/ejhf.196 25410653 Akpek M, et al. Protective effects of spironolactone against anthracycline-induced cardiomyopathy. …

Randomized clinical trial to compare the efficacy of ivermectin versus placebo to negativize nasopharyngeal PCR in patients with early COVID-19 in Peru (SAINT-Peru): a structured summary of a study protocol for randomized controlled trial.

OBJECTIVES: The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-sev … nt. 6. Not current use of CYP 3A4 or P-gp inhibitor drugs such as quinidine, amiodarone, diltiazem, spironolactone, verapamil, clarithromycin, erythromycin, itraconazole, ketoconazole, cyclosporine, tacrolimus, indinavir, ritonavir, cobicistat or critical CYP3A4 substrate drugs such as warfarin. Exclusion criteria 1. COVID-19 pneumonia diagnosed by the attending …

Obesity definition, diagnosis, bias, standard operating procedures (SOPs), and telehealth: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022.

BackgroundThe Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding definition, diagnosis, bias, standard operating procedures (SOPs) and telehealth is intended to provide clinicians an overview of obesity medicine and provide basic organizational tools towards establishing, directing, managing, and maintaining an obesity medical practice.MethodsThis CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by Obesity Medicine Association leadership.ResultsOMA has defined obesity as: "A chronic, progressive, relapsing, and

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… , metformin Infertility Clomiphene Hyperandrogenemia Gonadotropin releasing hormone analogs Ketoconazole Corticosteroids Spironolactone Flutamide Hypercholesterolemia Statins Table 12 Obesity and Adiposopathy Increase the Risk of Sex-Related Genitourinary Cancers. [ [131] , [132] , [133] , [134] , [135 … , metformin Infertility | Clomiphene Hyperandrogenemia | Gonadotropin releasing hormone analogs Ketoconazole Corticosteroids Spironolactone Flutamide Hypercholesterolemia | Statins Table 12 Obesity and Adiposopathy Increase the Risk of Sex-Related Genitourinary Cancers. [ [131] , [132] , [133] , [134 …

Coexistence of double seropositivity for MPO antibody and anti-GBM antibody in ANCA-associated vasculitis concurrent with multiple myeloma: A case report.

RationaleImmune-mediated vasculitis with 2 or more autoantibodies, for example, anti-proteinase-3, combined with anti-myeloperoxidase (MPO) or anti-glomerular basement membrane (GBM) antibodies, is extremely unusual. Furthermore, the coexistence of autoimmune vasculitis and hematological malignancies is uncommon. Herein, we describe a case of double-seropositive anti-neutrophil cytoplasmic antibody (ANCA) vasculitis with multiple myeloma.Patient concernsA 79-year-old Asian man presented with persistent leg edema and kidney dysfunction. His kidney function rapidly decreased, and serologic test

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… He was taking clopidogrel, telmisartan, and spironolactone for a history of underlying stroke and essential hypertension, and his baseline kidney function had not yet been established. …

Transjugular intrahepatic portosystemic shunts for adults with hepatorenal syndrome.

BACKGROUND: Hepatorenal syndrome is a condition that occurs in people with chronic liver disease (such as alcoholic hepatitis, advanced cirr … ts). The co-interventions used in the trials were dietary treatment (sodium less than 60 mmoL/day), spironolactone (300 mg/day to 400 mg/day), and furosemide (120 mg/day). Follow-up was up to 24 months. Both were multicentre trials from Spain and the USA, and Germany, conducted between 1993 and 2002. Most participants were men (aged 18 to 75 years). We are uncer …

Pregabalin-associated myoclonic encephalopathy without evidence of drug accumulation in a patient with acute renal failure.

Pregabalin, used for treating partial epilepsy and neuropathic pain, is usually well tolerated. Patients with impaired renal function are at risk to develop more serious adverse events. A 64-year-old woman was admitted in the Emergency Department for altered consciousness and abnormal movements. She recently started to take pregabalin (150 mg/day) for neuropathic pain. The drug was withdrawn 36 h before hospitalization following worsening of neurological symptoms. At physical examination, myoclonus was noted as main finding in the limbs and head, with encephalopathy. Laboratory investigations

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… Her current medications included clonazepam, amlodipine, L-thyroxin, metformin, repaglinide, spironolactone, furosemide, minoxidil, irbesartan, hydrochlorothiazide, acyclovir, pantoprazole, and fenofibrate. …

Interventions for female pattern hair loss.

BACKGROUND: Female pattern hair loss (FPHL), or androgenic alopecia, is the most common type of hair loss affecting women. It is characteris … easured from baseline.Further randomised controlled trials of other widely-used treatments, such as spironolactone, finasteride (different dosages), dutasteride, cyproterone acetate, and laser-based therapy are needed.