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BMC Cardiovascular Disorders Feb 2024BRASH syndrome (Bradycardia, Renal failure, Atrioventricular (AV) nodal blocking agent, Shock and Hyperkalemia) is a recently emerging diagnosis that describes the...
INTRODUCTION
BRASH syndrome (Bradycardia, Renal failure, Atrioventricular (AV) nodal blocking agent, Shock and Hyperkalemia) is a recently emerging diagnosis that describes the profound bradycardia seen in patients on AV nodal blockers who present with acute kidney injury (AKI) and hyperkalemia.
CASE PRESENTATION
We present a case of a 68 years old female patient with past history of hypertension taking atenolol and Enalapril presented to emergency department with the complaint of loss of consciousness of 02 hours duration. She had 03 days history of fatigue, poor oral intake, decreased urine output, appetite loss, vertigo and global headache. Her vital signs were blood pressure of 60/40 mmHg, absent radial pulse and temperature of 36.4 °C. Her systemic examination was remarkable for dry buccal mucosa; apical heart rate was 22 beats per minute. Glasgow Coma Scale was 13/15. Her laboratory tests showed creatinine of 1.83 mg/dL, blood urea nitrogen of 89 mg/dL and potassium elevated to the level of 6.39 mEq/dL. ECG revealed complete heart block with a normal QT interval and T waves and no U waves with ventricular rate of 22 beats per minute. Her previous medications were discontinued and the patient was resuscitated with intravenous (IV) fluids. She was given 03 doses of 1 mg atropine every 5 minutes but there was no increment in heart rate. She was given 50% dextrose with 10 international units of regular insulin, 1 g of calcium gluconate and Intravenous perfusion of norepinephrine and dopamine. Subsequently, after 14 hours of ICU admission the patient had a cardiac arrest with asystole and resuscitation was attempted but she couldn't survive.
CONCLUSION
BRASH syndrome is largely an under-recognized life threatening clinical diagnosis. Physicians should have high index of suspicion for BRASH when they encounter patients with bradycardia, hyperkalemia, and renal failure, as timely diagnosis is crucial in the management.
Topics: Humans; Female; Aged; Bradycardia; Hyperkalemia; Atrioventricular Block; Arrhythmias, Cardiac; Renal Insufficiency; Syndrome; Heart Arrest
PubMed: 38373878
DOI: 10.1186/s12872-024-03782-6 -
Psychopharmacology Mar 2024Although the study of emotions can look back to over 100 years of research, it is unclear which information the brain uses to construct the subjective experience of an...
RATIONALE
Although the study of emotions can look back to over 100 years of research, it is unclear which information the brain uses to construct the subjective experience of an emotion.
OBJECTIVE
In the current study, we assess the role of the peripheral and central adrenergic system in this respect.
METHODS
Healthy volunteers underwent a double inhalation of 35% CO, which is a well-validated procedure to induce an intense emotion, namely panic. In a randomized, cross-over design, 34 participants received either a β-blocker acting selectively in the peripheral nervous system (atenolol), a β-blocker acting in the peripheral and central nervous system (metoprolol), or a placebo before the CO inhalation.
RESULTS
Heart rate and systolic blood pressure were reduced in both β-blocker conditions compared to placebo, showing effective inhibition of the adrenergic tone. Nevertheless, the subjective experience of the induced panic was the same in all conditions, as measured by self-reported fear, discomfort, and panic symptom ratings.
CONCLUSIONS
These results indicate that information from the peripheral and central adrenergic system does not play a major role in the construction of the subjective emotion.
Topics: Humans; Adrenergic beta-Antagonists; Carbon Dioxide; Emotions; Fear; Heart Rate; Panic; Nervous System
PubMed: 38363344
DOI: 10.1007/s00213-024-06548-2 -
Environmental Science & Technology Mar 2024Sidestream serves as an important reservoir collecting pharmaceuticals from sludge. However, the knowledge on sidestream pharmaceutical removal is still insufficient. In...
Sidestream serves as an important reservoir collecting pharmaceuticals from sludge. However, the knowledge on sidestream pharmaceutical removal is still insufficient. In this work, atenolol biodegradation during sidestream partial nitritation (PN) processes characterized by high free nitrous acid (FNA) accumulation was modeled. To describe the FNA inhibition on ammonia oxidation and atenolol removal, Vadivelu-type and Hellinga-type inhibition kinetics were introduced into the model framework. Four inhibitory parameters along with four biodegradation kinetic parameters were calibrated and validated separately with eight sets of batch experimental data and 60 days' PN reactor operational data. The developed model could accurately reproduce the dynamics of nitrogen and atenolol. The model prediction further revealed that atenolol biodegradation efficiencies by ammonia-oxidizing bacteria (AOB)-induced cometabolism, AOB-induced metabolism, and heterotrophic bacteria-induced biodegradation were 0, ∼ 60, and ∼35% in the absence of ammonium and FNA; ∼ 14, ∼ 29, and ∼28% at 0.03 mg-N L FNA; and 7, 15, and 5% at 0.19 mg-N L FNA. Model simulation showed that the nitritation efficiency of ∼99% and atenolol removal efficiency of 57.5% in the PN process could be achieved simultaneously by controlling pH at 8.5, while 89.2% total nitrogen and 57.1% atenolol were removed to the maximum at pH of 7.0 in PN coupling with the anammox process. The pH-based operational strategy to regulate FNA levels was mathematically demonstrated to be effective for achieving the simultaneous removal of nitrogen and atenolol in PN-based sidestream processes.
Topics: Nitrous Acid; Atenolol; Ammonia; Nitrogen; Oxidation-Reduction; Bioreactors; Ammonium Compounds; Sewage; Nitrites
PubMed: 38358933
DOI: 10.1021/acs.est.3c10107 -
European Heart Journal Apr 2024Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure...
BACKGROUND AND AIMS
Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure (BP) control, but with differential BPV, is uncertain. Morbidity and mortality follow-up of UK participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm has been extended for up to 21 years to determine the CV impact of mean systolic blood pressure (SBP) control and BPV during the trial, and amongst those allocated to amlodipine- and atenolol-based treatment.
METHODS
Eight thousand five hundred and eighty hypertensive participants (4305 assigned to amlodipine ± perindopril-based and 4275 to atenolol ± diuretic-based treatment during the in-trial period (median 5.5 years) were followed for up to 21 years (median 17.4 years), using linked hospital and mortality records. A subgroup of participants (n = 2156) was followed up 6 years after the trial closure with a self-administered questionnaire and a clinic visit. In-trial mean SBP and standard deviation of visit-to-visit SBP as a measure of BPV, were measured using >100 000 BP measurements. Cox proportional hazard models were used to estimate the risk [hazard ratios (HRs)], associated with (i) mean with SBP and BPV during the in-trial period, for the CV endpoints occurring after the end of the trial and (ii) randomly assigned treatment to events following randomization, for the first occurrence of pre-specified CV outcomes.
RESULTS
Using BP data from the in-trial period, in the post-trial period, although mean SBP was a predictor of CV outcomes {HR per 10 mmHg, 1.14 [95% confidence interval (CI) 1.10-1.17], P < .001}, systolic BPV independent of mean SBP was a strong predictor of CV events [HR per 5 mmHg 1.22 (95% CI 1.18-1.26), P < .001] and predicted events even in participants with well-controlled BP. During 21-year follow-up, those on amlodipine-based compared with atenolol-based in-trial treatment had significantly reduced risk of stroke [HR 0.82 (95% CI 0.72-0.93), P = .003], total CV events [HR 0.93 (95% CI 0.88-0.98), P = .008], total coronary events [HR 0.92 (95% CI 0.86-0.99), P = .024], and atrial fibrillation [HR 0.91 (95% CI 0.83-0.99), P = .030], with weaker evidence of a difference in CV mortality [HR 0.91 (95% CI 0.82-1.01), P = .073]. There was no significant difference in the incidence of non-fatal myocardial infarction and fatal coronary heart disease, heart failure, and all-cause mortality.
CONCLUSIONS
Systolic BPV is a strong predictor of CV outcome, even in those with controlled SBP. The long-term benefits of amlodipine-based treatment compared with atenolol-based treatment in reducing CV events appear to be primarily mediated by an effect on systolic BPV during the trial period.
Topics: Humans; Blood Pressure; Atenolol; Antihypertensive Agents; Hypertension; Amlodipine; Risk Factors
PubMed: 38291599
DOI: 10.1093/eurheartj/ehad814 -
The Science of the Total Environment Mar 2024Pharmaceutical residues are increasingly becoming a significant source of environmental water pollution and ecological risk. This study, leveraging official national...
Pharmaceutical residues are increasingly becoming a significant source of environmental water pollution and ecological risk. This study, leveraging official national pharmaceutical sales statistics, predicts the environmental concentrations of 33 typical pharmaceuticals in the Tianjin area. The results show that 52 % of the drugs have a PEC/MEC (Predicted Environmental Concentration/Measured Environmental Concentration) ratio within the acceptable range of 0.5-2, including atenolol (1.21), carbamazepine (1.22), and sulfamethoxazole (0.91). Among the selected drugs, tetracycline, ciprofloxacin, and acetaminophen had the highest predicted concentrations. The EPI (Estimation Programs Interface) biodegradation model, a tool from the US Environmental Protection Agency, is used to predict the removal efficiency of compounds in wastewater treatment plants. The results indicate that the EPI predictions are acceptable for macrolide antibiotics and β-blockers, with removal rates of roxithromycin, spiramycin, acetaminophen, and carbamazepine being 14.1 %, 61.2 %, 75.1 %, and 44.5 %, respectively. However, the model proved to be less effective for fluoroquinolone antibiotics. The ECOSAR (Ecological Structure-Activity Relationships) model was used to supplement the assessment of the potential impacts of drugs on aquatic ecosystems, further refining the analysis of pharmaceutical environmental risks. By combining the concentration and detection frequency of pharmaceutical wastewater, this study identified 9 drugs with significant toxicological risks and marked another 24 drugs as substances of potential concern. Additionally, this study provides data support for addressing pharmaceutical residues of priority concern in subsequent research.
Topics: Wastewater; Waste Disposal, Fluid; Wastewater-Based Epidemiological Monitoring; Water Pollutants, Chemical; Ecosystem; Acetaminophen; Environmental Monitoring; Anti-Bacterial Agents; Carbamazepine; Pharmaceutical Preparations
PubMed: 38262535
DOI: 10.1016/j.scitotenv.2024.170204 -
Dermatology (Basel, Switzerland) 2024Infants with infantile hemangioma (IH) have been effectively treated with propranolol or atenolol. Concerns were raised about the mental health of these children at...
BACKGROUND
Infants with infantile hemangioma (IH) have been effectively treated with propranolol or atenolol. Concerns were raised about the mental health of these children at school age, due to central nervous system effects of propranolol and visible nature of IH.
OBJECTIVE
This study aimed to compare the mental health at school age of children treated with propranolol to children treated with atenolol for IHs and their parents.
METHODS
This two-centered cross-sectional study included children aged ≥6 years and treated with either propranolol or atenolol for IH during infancy. Children's outcomes were performance-based affect recognition (Dutch version of the Developmental Neuropsychological Assessment-II [NEPSY-II-NL]), parent-reported emotional and behavioral functioning (Child Behavioral Checklist [CBCL]), and health-related quality of life (KIDSCREEN-27). Parents' outcome was parenting stress (Parenting Stress Questionnaire [OBVL]).
RESULTS
Data of 105 children (36 propranolol, 69 atenolol; 6.0-11.8 years) were analyzed. Mental health outcomes did not differ between both β-blocker groups. Although overall functioning was in line with norms, children presented specific problems concerning affect recognition, parent-reported attention, and social quality of life. Parents showed increased physical symptoms, depressive symptoms, and parent-child relationship problems.
CONCLUSION
No difference in mental health at school age was found between children treated with propranolol or atenolol for IH. Although few overall mental health problems were found, specific problems require follow-up. Follow-up of children should be directed toward affect recognition, attention, and social functioning in daily life. Problems reported by parents could be ameliorated by mental health support during and after their infant's β-blocker treatment.
Topics: Infant; Humans; Child; Atenolol; Propranolol; Mental Health; Cross-Sectional Studies; Quality of Life; Hemangioma, Capillary; Adrenergic beta-Antagonists; Parents
PubMed: 38228125
DOI: 10.1159/000536144 -
Biomedicine & Pharmacotherapy =... Feb 2024Telmisartan is an antagonist of the angiotensin II receptor used in the management of hypertension (alone or in combination with other antihypertensive agents. It... (Review)
Review
Telmisartan is an antagonist of the angiotensin II receptor used in the management of hypertension (alone or in combination with other antihypertensive agents. It belongs to the drug class of angiotensin II receptor blockers (ARBs). Among drugs of this class, telmisartan shows particular pharmacologic properties, including a longer half-life than any other angiotensin II receptor blockers that bring higher and persistent antihypertensive activity. In hypertensive patients, telmisartan has superior efficacy than other antihypertensive drugs (losartan, valsartan, ramipril, atenolol, and perindopril) in controlling blood pressure, especially towards the end of the dosing interval. Telmisartan has a partial PPARγ-agonistic effect whilst does not have the safety concerns of full agonists of PPARγ receptors (thiazolidinediones). Moreover, telmisartan has an agonist activity on PPARα and PPARδ receptors and modulates the adipokine levels. Thus, telmisartan could be considered as a suitable alternative option, with multi-benefit for all components of metabolic syndrome including hypertension, diabetes mellitus, obesity, and hyperlipidemia. This review will highlight the role of telmisartan in metabolic syndrome and the main mechanisms of action of telmisartan are discussed and summarized. Many studies have demonstrated the useful properties of telmisartan in the prevention and improving of metabolic syndrome and this well-tolerated drug can be greatly proposed in the treatment of different components of metabolic syndrome. However, larger and long-duration studies are needed to confirm these findings in long-term observational studies and prospective trials and to determine the optimum dose of telmisartan in metabolic syndrome.
Topics: Humans; Telmisartan; Angiotensin Receptor Antagonists; Metabolic Syndrome; PPAR gamma; Prospective Studies; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Benzimidazoles; Hypertension; Antihypertensive Agents; Blood Pressure; Benzoates
PubMed: 38228033
DOI: 10.1016/j.biopha.2024.116169 -
Heliyon Dec 2023In this work, gold nanoparticles coated with polyvinylpyrrolidone (PVP-AuNPs) were used as a colorimetric probe for the sensitive, selective, simple, and rapid...
In this work, gold nanoparticles coated with polyvinylpyrrolidone (PVP-AuNPs) were used as a colorimetric probe for the sensitive, selective, simple, and rapid determination of atenolol (ATN). Indeed, atenolol triggered the aggregation of PVP-AuNPs via hydrogen bonding, electrostatic interactions, and dipole-dipole forces with PVP on the surface of AuNPs, causing the colloidal solution's color to shift from red to blue. SEM, TEM, FT-IR, UV-Vis, zeta potential, and other methods were used to characterise the PVP-AuNPs that were created as well as their aggregates. An excellent linear relationship between the absorption ratio (A690/A521) and the concentration of ATN in the range of 0.07-3.0 μM with a detection limit of 0.023 μM was discovered by optimising the experimental settings. The influence of potential interfering species on the measurement of ATN was investigated, and it was discovered that the developed colorimetric sensor had satisfactory selectivity. Finally, the presented method was used to measure ATN in tablet and blood plasma samples, and the obtained recovery values showed great promise for the use of the proposed sensor in clinical applications.
PubMed: 38213583
DOI: 10.1016/j.heliyon.2023.e22675 -
The Medical Letter on Drugs and... Jan 2024
Topics: Humans; Atrial Fibrillation
PubMed: 38180321
DOI: 10.58347/tml.2024.1693a -
Biological & Pharmaceutical Bulletin 2024We recently reported that the gastrointestinal (GI) fluid volume is influenced by the solution osmolality, and proposed that this effect may play a role in beverage-drug...
We recently reported that the gastrointestinal (GI) fluid volume is influenced by the solution osmolality, and proposed that this effect may play a role in beverage-drug interactions. Here, we investigated whether osmolality-dependent fluid secretion can explain the difference in the magnitudes of fruit juice-drug interactions depending on the type of fruit juice (grapefruit juice (GFJ), orange juice (OJ), and apple juice (AJ)). The osmolality of GFJ, OJ, and AJ used in this study was found to be 552, 686, and 749 mOsm/kg, respectively. Measurements of intestinal fluid movement following beverage administration by the in situ closed-loop technique revealed the following rank order for fluid volume in rat ileum: AJ > OJ > GFJ > purified water, suggesting that water movement is dependent on the osmolality of these beverages. Such changes in GI fluid volume are expected to alter the luminal drug concentration, potentially contributing to the magnitude of beverage-drug interactions. Indeed, in vivo pharmacokinetic study in rats revealed that the plasma concentration of atenolol, a low-permeability drug, was the highest after oral administration in purified water, followed by GFJ and OJ, and was the lowest after administration in AJ. In contrast, antipyrine, a high-permeability drug, showed no significant difference in plasma concentration after administration in purified water and fruit juices, suggesting that the absorption of high-permeability drugs is less affected by solution osmolality. Our findings indicate that differences in the magnitude of beverage-drug interactions can be at least partly explained by differences in the osmolality of the beverages ingested.
Topics: Rats; Animals; Malus; Fruit and Vegetable Juices; Citrus paradisi; Citrus sinensis; Food-Drug Interactions; Beverages; Osmolar Concentration; Water; Fruit
PubMed: 38171780
DOI: 10.1248/bpb.b23-00490