Bisoprolol 5mg / Aspirin 75mg capsules

ObjectiveThis randomized controlled trial aimed to compare the efficacy and safety of indobufen versus aspirin in reducing Target Vessel Restenosis (TVR) after Drug-Eluting Balloon (DEB) angioplasty in patients with Coronary Artery Disease (CAD).BackgroundDespite advancements in Percutaneous Coronary Intervention (PCI) techniques, TVR remains a significant challenge. Antiplatelet therapy is crucial in managing patients post-PCI, and while aspirin is the standard, indobufen may offer a more favorable safety profile by reducing gastrointestinal adverse reactions.MethodsThe authors conducted a prospective, single-blind, randomized controlled trial involving patients with CAD undergoing PCI with DEB. Patients were randomly allocated to receive either indobufen 100 mg twice daily or aspirin 100 mg daily, both in conjunction with clopidogrel 75 mg daily, for at least 12-months post-procedure. The primary endpoint was TVR assessed by quantitative coronary angiography at 12-months, while secondary endpoints included Major Adverse Cardiovascular Events (MACE), bleeding complications, and patient-reported outcomes.ResultsA total of 240 patients were evenly distributed between the indobufen and aspirin groups. No significant differences were observed in the rates of TVR (5.83 % vs. 7.50 %, p = 0.603) and MACE (5.00 % vs. 5.83 %, p = 0.776) between the two groups at one-year post-procedure. Importantly, no significant difference in gastrointestinal bleeding rates was observed between the indobufen and aspirin groups (p = 0.156).ConclusionIndobufen demonstrated non-inferior efficacy to aspirin in preventing TVR and MACE after DEB angioplasty in patients with CAD, with comparable safety profiles and no significant difference in gastrointestinal bleeding rates. However, indobufen is relatively more expensive than aspirin. While the present results suggest that indobufen may be a viable alternative to aspirin, particularly in patients at higher risk of gastrointestinal adverse reactions, this conclusion should be interpreted with caution due to the study's limitations, including its single-blind design and relatively small sample size.

Abstract licence: CC BY

Latar Belakang: Sepsis merupakan keadaan disfungsi organ yang mengancam jiwa di mana terjadi disregulasi respon tubuh terhadap infeksi. Sepsis dikaitkan dengan pelepasan katekolamin endogen masif yang memberikan hasil klinis buruk. Takikardia merupakan prognostik yang buruk pada pasien sepsis. Pasien sepsis dengan takikardi yang mendapat terapi beta-blocker dihubungkan dengan penurunan angka kematian. Bisoprolol merupakan antagonis selektif-ß1 yang mempunyai efek kronotropik negatif. Penggunaan beta-blocker dapat berkontribusi pada perlindungan sistemik dari lonjakan katekolamin yang terjadi selama sepsis. Bisoprolol menurunkan denyut jantung sehingga dapat mengurangi kontraktilitas miokard, lalu mengurangi kebutuhan oksigen miokard yang meningkat pada pasien sepsis.Metode: Penelitian ini merupakan randomized clinical trial (RCT) dengan double blind. Pengumpulan data dengan metode prospektif dilaksanakan di RSUP. H. Adam Malik Medan periode Desember 2022 – Februari 2023. Pemilihan sampel dengan consecutive sampling yang memenuhi kriteria inkusi dan eksklusi. Semua sampel akan diambil data denyut jantung, tekanan darah, tekanan arteri rata-rata (MAP), dan laktat yang nantinya akan dilakukan perhitungan secara statistik. lanjut dengan secara statistik.Hasil: Dengan uji T Independent pada denyut jantung, tekanan darah sistol, tekanan darah diastol, dan MAP pada 2 jam dan 12 jam setelah perlakuan terdapat perbedaan yang signifikan, didapatkan nilai p < 0,05. Hasil serupa didapatkan pada pemeriksaan laktat pada 24 jam setelah perlakuan, terdapat perbedaan yang signifikan, nilai p < 0,05.Simpulan: Berdasarkan hasil studi kami, terdapat perbedaan yang bermakna antara pemberian bisoprolol 2,5 mg dan bisoprolol 5 mg. Pada penelitian ini menunjukkan bahwa pada pemberian bisoprolol 5 mg lebih efektif dibandingkan dengan bisoprolol 2,5 mg dalam menurunkan denyut jantung pada pasien sepsis

Abstract licence: CC BY-NC 4.0

Erythromelalgia is a rare neurovascular syndrome characterized by intense, episodic burning pain that primarily affects the feet and hands and, occasionally, the face. Symptoms are often triggered by heat and exercise, with relief typically achieved through cooling methods. However, improper use of these techniques can lead to serious complications, such as trench foot and cellulitis. The condition can also have significant psychological effects, contributing to anxiety and depression. An 18-year-old Lebanese woman with primary erythromelalgia and a family history of the condition presented with worsening bilateral pain and erythema in her lower extremities. Her pain was poorly controlled, prompting her to engage in prolonged ice-water immersion, which resulted in skin abrasions, necrotic ulcers, and cellulitis. On admission, she exhibited bilateral lower extremity erythema, edema, tenderness, and macerated skin with necrotic ulcers on her left foot. Her nails showed white discoloration and onycholysis. Laboratory tests were normal, and Doppler ultrasound revealed increased blood flow, supporting the diagnosis of erythromelalgia. A multidisciplinary team managed her care, addressing infection, pain, and anxiety. She received antibiotics, wound care, and antifungal therapy for onychomycosis. Pain management included aspirin, pregabalin, topical lidocaine, acetaminophen, nefopam, and opiates; however, due to persistent pain, her regimen was adjusted to incorporate morphine and additional agents. Duloxetine was also introduced to address both anxiety and pain. After two days on the revised treatment plan, her pain improved significantly, allowing for discharge. Follow-up visits confirmed skin healing, and Doppler ultrasound again demonstrated increased blood flow. This case highlights the complexity of managing severe erythromelalgia, underscoring the importance of appropriate pain management, patient education, and multidisciplinary care. It represents the first reported case of erythromelalgia requiring hospitalization in Lebanon and illustrates the potential complications of inadequate management and inappropriate use of cooling techniques.

Abstract licence: CC BY

BackgroundManaging elderly patients with simultaneous acute cardiovascular and orthopedic emergencies presents a unique challenge. While ST-elevation myocardial infarction (STEMI) requires prompt revascularization and dual antiplatelet therapy (DAPT), pertrochanteric femoral fractures usually necessitate early surgical fixation to reduce morbidity and mortality. However, the combination of these conditions complicates both standard treatment pathways.Case presentationWe present the case of an 86-year-old woman admitted after a low-energy fall, with a radiologically confirmed unstable pertrochanteric fracture of the right femur (AO/OTA 31-A2). Upon routine electrocardiogram, anterior STEMI with new-onset atrial fibrillation was diagnosed. Although asymptomatic from a cardiac perspective, bedside echocardiography revealed a severely reduced left ventricular ejection fraction of 10%. Urgent coronary angiography demonstrated a critical mid-left anterior descending lesion, successfully treated with rotational atherectomy, intravascular lithotripsy, and stent implantation. She was initiated on DAPT (aspirin + clopidogrel) and anticoagulated with low-molecular-weight heparin. Given the extremely high bleeding risk, surgical intervention for the femoral fracture was deemed unsafe. Instead, conservative management with skeletal traction (6 kg) was employed. Despite optimal supportive care and early rehabilitation, the patient experienced a complicated hospital course, including delirium, hematuria, and lower respiratory tract infection. She passed away 52 days post-admission.ConclusionsThis case illustrates the complexity of clinical decision-making in geriatric patients with competing acute conditions. Current evidence on how to proceed in patients requiring both antithrombotic therapy and urgent orthopedic surgery is limited. Multidisciplinary teams must carefully weigh the risks and benefits of both surgical and conservative strategies. Further guidelines addressing such scenarios in elderly patients are urgently needed.

Abstract licence: CC BY

BackgroundEvidence on associations between drug-drug interactions (DDIs) and health outcomes in the older community-dwelling population is limited.ObjectiveWe estimate potentially clinically important DDI prevalence and examine the association between DDIs and (1) adverse drug events (ADEs), (2) emergency hospital attendance and (3) health-related quality of life (HRQoL) in an older community-dwelling population in Ireland.MethodsThis is a prospective cohort study of community-dwelling older adults (N = 904) aged ≥ 70 years from 15 general practices in Ireland recruited in 2010 (wave-1) and followed-up over 2 years (wave-2; 2012-2013), with linked national pharmacy claims data. Individuals dispensed two or more drugs (wave-1: N = 842; wave-2: N = 763) were included. DDI prevalence at baseline, follow-up and 6 months prior to each health outcome was estimated. Multi-level regression was used to model the association between DDI-exposure and health outcomes at follow-up. DDI prevalence, adjusted incidence-rate ratios (aIRR), adjusted odds ratios (aOR), β coefficients and robust standard error (RSE) from multi-level regression analyses, and 95% confidence intervals (CIs) are reported.ResultsAt wave-1, n = 196 (23.3% [95% CI 20.5-26.3]), individuals were potentially exposed to ≥ 1 DDI, increasing to n = 345 (45.2% [41.7-48.9]) at wave-2. At 2-year follow-up, the median number of ADEs was 3 (interquartile range [IQR 2-5]); 229 (30.1%) had ≥ 1 emergency hospital attendance, and the mean EQ-5D was 0.74 (± 0.23). Evidence for the association between DDI-exposure and emergency hospital attendance at follow-up was lacking (aOR = 1.38 [0.42-4.53]). DDI-exposure was associated with an increasing number of ADEs (aIRR = 1.26 [1.03-1.55]), and decreasing EQ-5D utility (β = - 0.07, [-0.11 to -0.04], RSE = 0.02). Aspirin-warfarin, clarithromycin-prednisolone, amiodarone-furosemide, clarithromycin-salbutamol, rosuvastatin-warfarin, amiodarone-bisoprolol, and aspirin-nicorandil were common DDIs 6 months preceding these health outcomes.ConclusionsWe found a two-fold increase in DDI prevalence between wave 1 and 2. DDI exposure was associated with increasing ADEs and declining HRQoL at 2-year follow-up. Common DDIs involved anticoagulants, cardiovascular and antimicrobial drugs, which should be targeted for medicine optimisation.

Abstract licence: CC BY-NC