SGLT2 inhibitors among patients with heart failure with preserved ejection fraction: A meta-analysis of randomised controlled trials

BACKGROUND

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been recommended in the practice guidelines for the treatment of patients with heart failure with reduced ejection fraction; however, their effects among patients with preserved ejection fraction have been debatable.

OBJECTIVE

We aim to evaluate the SGLT2 inhibitor effect among patients with heart failure with reduced ejection fraction, including DELIVER and EMPEROR-Preserved trials.

METHODS

We performed a systematic literature search using the PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until August 30th, 2022. Statistical analysis was performed by calculating hazard ratio (HR) using the random effect model with a 95% confidence interval (CI) and probability value (P). Statistical significance was met if 95% CI does not cross numeric "1" and P < .05.

RESULTS

Six studies with a total of 15,989 total patients were included in the final analysis. The mean age of patients enrolled in SGLT2 inhibitors and placebo was 69.13 and 69.37 years, respectively. The median follow-up duration was 2.24 years. SGLT2 inhibitors reduced composite cardiovascular mortality or first hospitalization for heart failure (HR, 0.80 [95% CI: 0.74-0.87], P < .001, I2 = 0%), heart failure hospitalization (HR, 0.74 [95% CI: 0.67-0.82], P < .001, I2 = 0%) compared with placebo. However, all-cause mortality (HR, 0.97 [95% CI: 0.89-1.06], P = .54, I2 = 0%) and cardiovascular mortality (HR, 0.96 [95% CI: 0.82-1.13), P = .66, I2 = 35.09%] were comparable between both groups.

CONCLUSION

Our study finding shows that SGLT2 inhibitors significantly reduced the risk of first HF hospitalization or cardiovascular death and HF hospitalization; however, all-cause mortality was comparable between the groups.

A cost-effective IoT strategy for remote deployment of soft sensors - a case study on implementing a soft sensor in a multistage MBBR plant

Model-based soft sensors can enhance online monitoring in wastewater treatment processes. These soft sensor scripts are executed either locally on a programmable logic controller (PLC) or remotely on a system with data-access over the internet. This work presents a cost-effective, flexible, open source IoT solution for remote deployment of a soft sensing algorithm. The system uses low-priced hardware and open-source programming language to set up the communication and remote-access system. Advantages of the new IoT architecture are demonstrated through a case study for remote deployment of an Extended Kalman Filter (EKF) to estimate additional water quality parameters in a multistage moving bed biofilm reactor (MBBR) plant. The soft-sensor results are successfully validated against standardised laboratory measurements to prove their ability to provide real-time estimations.

Studies on the immunomodulatory effects of Boerhaavia diffusa alkaloidal fraction

The alkaloidal fraction of Boerhaavia diffusa was studied for its effect on cellular and humoral functions in mice. Oral administration of the fraction (25-100 mg/kg) significantly inhibited SRBC-induced delayed hypersensitivity reactions in mice. However, the inhibition was observed only during post-immunisation drug treatment, while no effect during pre-immunisation drug treatment was observed. A significant dose-related increase in antibody titre was observed during pre- and post-immunisation treatment. The alkaloidal fraction failed to show any blastogenic responsiveness of murine splenocytes to Concanvalin A (Con A) and lipopolysaccharide (LPS). Similarly, it did not display any mitogenic activity. Thus, the present study has shown the in vivo immunostimulatory activity of B. diffusa alkaloidal fraction without an in vitro effect.

Studies on the anti-inflammatory and analgesic activity of Cedrus deodara (Roxb.) Loud. wood oil

The volatile oil extracted by steam distillation of the wood of Cedrus deodara was examined for its oral anti-inflammatory and analgesic activity at the doses of 50 and 100 mg/kg body weight. It produced significant inhibition of carrageenan-induced rat paw edema and of both exudative-proliferative and chronic phases of inflammation in adjuvant arthritic rats at doses of 50 and 100 mg/kg body weight. The oil at both tested doses was found to possess analgesic activity against acetic acid-induced writhing and hot plate reaction in mice.

Mast cell stabilizing and lipoxygenase inhibitory activity of Cedrus deodara (Roxb.) Loud. wood oil

Volatile oil of C. deodara, administered orally at the doses of 50, 100 and 200 mg/kg body weight, significantly inhibited the pedal edema induced by compound 48/80 in rats. The oil significantly inhibited compound 48/80 induced degranulation of isolated rat peritoneal mast cells at concentrations ranging from 25-200 micrograms/ml. C. deodara wood oil also significantly inhibited the enzyme lipoxygenase at a concentration of 200 micrograms/ml. Thus, the anti-inflammatory activity of C. deodara wood oil could be attributed to its mast cell stabilizing activity and the inhibition of leukotriene synthesis.

Antiallergic potential of furosemide

Recent reports have indicated the effectiveness of furosemide in inhibiting responses to inhaled allergen and in treating allergic conjunctivitis. In the present study furosemide was tested for its antiallergic potential using compound 48/80 induced paw edema and in vitro mast cell degranulation. Furosemide was found to significantly inhibit compound 48/80 paw edema and compound 48/80 induced histamine release. Furosemide was also found to inhibit histamine release during passive peritoneal anaphylaxis in rats. The results suggest that furosemide may be inhibiting the release of mediators of anaphylaxis from the mast cells.

The sterols of the khapra beetle, Trogoderma granarium Everts

The khapra beetle, Trogoderma granarium Everts, does not dealkylate and convert dietary C28- or C29-Phytosterols to C27-sterols such as cholesterol. There is, however, an increase in the concentration of cholesterol and campesterol in its tissues relative to the dietary concentrations of these sterols, presumably as a result of selective uptake.

Studies on the cholesterol ester hydrolase of Trogoderma (Coleoptera)

The enzyme cholesterol ester hydrolase (EC 3.1.1.13) was detected in the larvae of the khapra beetle, Trogoderma granarium (Everts). The pH and temperature optima for the enzyme were 6.6 degrees and 37 degrees C respectively. The mol.wt. of the enzyme was 76000-80000. The enzyme was equally effective in hydrolysing cholesteryl acetate, stearate and oleate. Cholesterol derivatives, namely the chloride and the methyl ether, inhibited the enzyme activity almost completely. It was also inhibited completely by p-hydroxymercuribenzoate. This inhibition was reversed by the addition of dithiothreitol, reduced glutathione or cysteine. The enzyme activity was associated predominantly with the 104000 g fraction.