Abstract 4144167: Efficacy of Stem Cell Transplantation in Cardiac Regeneration and Function in Ischemic Heart Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Author: Baskara Salian, Rishabh ; Nandipi, Vibha Sri ; Shivani, Ravipati ; Suvvari, Tarun Kumar ; Kaur, Sakoon ; MICHAEL, ANITA ; Ahmad, Osama ; Mathew, Bejoi ; Bhargav pradeep, konakanchi ; Vasini, Vindhya ; Banerjee, Sumitaksha

Background: Myocardial ischemia remains a significant global health concern for cardiovascular morbidity and mortality. In addition to the traditional treatment modalities, stem cell transplantation is emerging as a promising therapeutic intervention for cardiac regeneration and functional recovery. Our study evaluated the efficacy and clinical impact of SCT by reducing infarct scar size and improving cardiac function. The secondary objectives are to compare stem cell types, identify optimal transplantation strategies, and address safety and feasibility.Method: Randomized controlled trials from January 2000 to July 2023 were collected from PubMed, Cochrane, Google Scholar, and Elsevier. Based on criteria and evidence quality, screening and selection were done. A RevMan analysis was done. Infarct size, LVEF, LVESV, LVEDV, and mortality were measured. Comparator variables included placebo, medical therapy, CABG, and other types of stem cells. Randomization, allocation concealment, blinding, and therapeutic interventions differed among trials. Heterogeneity and publication bias were assessed using random-effects model and funnel plots. Sensitivity analysis and meta-regression identified outcome variability.Results: Seventeen studies (n = 1022 patients) met the inclusion criteria, encompassing various cell types, doses, and administration routes. Compared to controls, SCT greatly enhanced LVEF (MD: 3.39, 95% CI: 1.05 to 5.73, p = 0.005) and reduced infarct size (MD: 14.23, 95% CI: 7.12 to 21.35, p<0.0001) with an average dose of 2.03 x 107 cells/ml injected intracoronarily directly into the infarcted myocardium or the target vessel. LVESV (MD: -2.63, 95% CI: -7.99 to 2.73, p = 0.34) or LVEDV (MD: -2.00, 95% CI: -4.40 to 0.40, p = 0.10) did not improve. Differences in mortality rates were insignificant (OR: 0.71, 95% CI: 0.29 to 1.74, p = 0.46). A diverse range of patients was included, leading to moderate heterogeneity (I^2 = 52%).Conclusion: SCT shows potential benefits for cardiac regeneration and functional improvement. The analysis is robust, with no publication bias and mild attrition bias issues. Due to low mortality, safety was comparable to conventional therapy. These findings highlight the need for SCT strategy optimization and long-term clinical outcome studies.

02 Nov 2024·Journal of Prescribing Practice

Finerenone and diabetic renal disease: a narrative review

Author: Verghese, Anna Tintu ; Harimohan, Hridaya ; Prakash, Vishakh ; Haroon, Nisha Nigil ; Ravisankar, Nikitha ; Mathews, Arpita ; Cherian, Somy ; Cheryeth, Mabel ; Venkatesan, Kirthika ; Unnikrishnan, Parvathy ; James, Sandra

Overactivation of mineralocorticoid receptors occurs in cardiorenal diseases. Many patients with type 2 diabetes often progress to chronic kidney disease (CKD) and require dialysis. Finerenone is the first oral non-steroidal mineralocorticoid receptor antagonist used in patients with diabetic kidney disease and heart failure. Finerenone (Kerendia®) is more potent than spironolactone in reducing inflammation and fibrosis in CKD and exerts its effect equally on the heart and kidneys, improving cardiovascular outcomes. Research demonstrates that finerenone improves proteinuria and glomerular filtration rate if taken alone or in combination with sodium-glucose transporter 2 inhibitors. Finerenone has been found to decrease mortality in patients with diabetic renal disease and improve quality of life. Its side effects, unlike those of spironolactone, do not include gynecomastia. However, it can result in hyperkalemia, which needs to be monitored. In this review, we aim to investigate the mechanisms of action of finerenone and its implications in patients with type 2 diabetes.

18 Aug 2024·Cureus

Unveiling Morphological Diversity: An Anatomical Investigation of the Foramen Transversarium in the Cervical Vertebrae

Article

Author: G, Deepa ; G N, Kusneniwar ; Chandrupatla, Mrudula ; B H, Shrikrishna ; J, Ratna Prabha

PURPOSEThis study aimed to investigate the morphological variations in the foramen transversarium of the cervical vertebrae and their clinical implications. Understanding these variations is crucial for accurate diagnosis, treatment planning, and surgical procedures involving the cervical spine.MATERIALS AND METHODSThis descriptive cross-sectional study was conducted at the AIl India Institute of Medical Sciences, Bibinagar, India, and involved 150 dry cervical vertebrae specimens. Measurements of the anteroposterior and transverse dimensions, as well as anatomical variations such as accessory foramina and bilateral symmetry, were recorded using vernier calipers.RESULTSOut of 150 vertebrae, 149 had foramina on both sides, while one had a single foramen on the right. The anteroposterior diameter ranged from 1.0 to 10.0 mm on the right (mean: 5.13 ± 1.25 mm) and 2.0 to 8.5 mm on the left (mean: 5.08 ± 1.11 mm). The transverse diameter ranged from 2.0 to 9.0 mm on the right (mean: 5.54 ± 1.06 mm) and 2.0 to 8.0 mm on the left (mean: 5.42 ± 1.07 mm). Statistical analysis indicated symmetry in morphological dimensions. The morphological variations included unilateral and bilateral accessory foramina, incomplete accessory foramina, and asymmetrical foramina. Circular shapes were predominant (76% on the right, 75% on the left), with other shapes, such as oval and irregular shapes, being less common.CONCLUSIONThese findings enhance the understanding of cervical spine anatomy, aiding in the interpretation of radiographic images and the planning of surgical procedures. This research highlights the need for precise anatomical knowledge to improve patient outcomes in cervical spine-related interventions.

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