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Majumder ABD, Rahman MT, Islam AKM, Ullah M, Zaman MK, Reza MA, Islam MS, Khan RC, Rahman MZ, Rahman MM, Awal MA, Kabir S, Paul GK, Nasrin S, Zaman S. Evaluation of outcome of Coronavirus disease 2019 patients receiving RAAS inhibitors (OCRAS study): a prospective observational study of Bangladeshi hypertensive patients. Eur Heart J 2022. [PMCID: PMC9383380 DOI: 10.1093/eurheartj/ehab849.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Beximco Pharmaceutical Limited, Bangladesh
OnBehalf
Cardiology Study Group (Bangladesh)
Background
The fact that SAARS-Cov2 virus enters cells through ACE2 receptors and the Renin-Angiotensin-Aldosterone System Inhibitors (RAASi) upregulate the ACE2 receptors, there was speculation that use of RAASi may lead increased cellular entry of the virus. There was a pause for a brief period of the use of RAASi in COVID 19 patients. But clinically the speculation has been found to be incorrect. Different professional societies come up with the assertion to continue to use RAASi. As the hesitancy among the clinicians appears to continue and there is no first hand data regarding the safety of the use of RAASi in Bangladeshi population, the study was undertaken to evaluate the safety of RAASi in COVID 19 patients.
Aims & Methods
This study was a prospective, observational multi-center study to evaluate the outcome of COVID-19 patients receiving RAAS inhibitors. Adult Hypertensive patients (age ≥18 years) with diagnosed COVID-19 confirmed by RT-PCR test who have a history of taking either ACE inhibitor/ARB or any other anti-hypertensive medication. Evaluation of outcome was assessed by rate of hospitalization, requirement of oxygen therapy, requirement of high flow nasal cannula, admission to ICU and mortality between two groups. All statistical analyses were performed using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA).
Results
We collected data from 147 Covid-19 positive patients confirmed by RT-PCR. Among them, 117 (79.6%) had a history of taking RAAS inhibitor and 30 had history of taking other antihypertensive medications. Of them, two-third patients had more than 50 years of age and more than half of the patients had overweight or obesity. Other than hypertension they had several comorbidities such as Diabetes Mellitus (45.4%), Ischemic Heart Diseases (35.4%), Asthma or COPD (15%) etc. Rate of hospitalization had no statistical difference between RAAS inhibitor group and other hypertensive group (48.7% vs 46.70% respectively; p-value - 0.841). There was no statistical difference between two groups in terms of requirement of oxygen therapy (p-value - 0.297), High Flow Nasal Cannula (p-value - 0.430), intensive care unit (p-value - 0.194) and death (p-value – 0.383) also. Almost half and one-third of the patients had persistence of symptoms even after 14 days and 28 days respectively. Fatigue, cough, breathlessness, loss of appetite and taste were the most common symptoms among those.
Conclusion
In our study we found that RAAS inhibitor treatment had no adverse effect on the outcome of COVID-19 patients compared with other antihypertensive drugs. Patients may continue receiving ACEIs and ARBs for the treatment of any indication for RAASi without an increased risk of worse outcomes.
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Affiliation(s)
| | - M T Rahman
- Col. Malek Medical College, Cardiology, Manikganj, Bangladesh
| | - A K M Islam
- National Institute of Cardiovascular Diseases, Cardiology, Dhaka, Bangladesh
| | - M Ullah
- Sir Salimullah Medical College, Cardiology, Dhaka, Bangladesh
| | - M K Zaman
- Dhaka Medical College, Cardiology, Dhaka, Bangladesh
| | - M A Reza
- Beximco Pharmaceuticals, Dhaka, Bangladesh
| | - M S Islam
- KY Medical College, Cardiology, Sirajganj, Bangladesh
| | - R C Khan
- Sher-E-Bangla Medical College, Barisal, Cardiology, Barisal, Bangladesh
| | - M Z Rahman
- National Institute of Cardiovascular Diseases, Cardiology, Dhaka, Bangladesh
| | - M M Rahman
- Rangpur Medical College, Cardiology, Rangpur, Bangladesh
| | - M A Awal
- Chittagong Medical College, Cardiology, Chittagong, Bangladesh
| | - S Kabir
- AR Medical College, Cardiology, Dinajpur, Bangladesh
| | - G K Paul
- Mymensingh medical college, Cardiology, Mymensingh, Bangladesh
| | - S Nasrin
- Ibrahim Cardiac Hospital & Research Institute, Cardiology, Dhaka, Bangladesh
| | - S Zaman
- National Institute of Cardiovascular Diseases, Cardiology, Dhaka, Bangladesh
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Keyvani-Ghamsari S, Khorsandi K, Rasul A, Zaman MK. Current understanding of epigenetics mechanism as a novel target in reducing cancer stem cells resistance. Clin Epigenetics 2021; 13:120. [PMID: 34051847 PMCID: PMC8164819 DOI: 10.1186/s13148-021-01107-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/19/2021] [Indexed: 12/13/2022] Open
Abstract
At present, after extensive studies in the field of cancer, cancer stem cells (CSCs) have been proposed as a major factor in tumor initiation, progression, metastasis, and recurrence. CSCs are a subpopulation of bulk tumors, with stem cell-like properties and tumorigenic capabilities, having the abilities of self-renewal and differentiation, thereby being able to generate heterogeneous lineages of cancer cells and lead to resistance toward anti-tumor treatments. Highly resistant to conventional chemo- and radiotherapy, CSCs have heterogeneity and can migrate to different organs and metastasize. Recent studies have demonstrated that the population of CSCs and the progression of cancer are increased by the deregulation of different epigenetic pathways having effects on gene expression patterns and key pathways connected with cell proliferation and survival. Further, epigenetic modifications (DNA methylation, histone modifications, and RNA methylations) have been revealed to be key drivers in the formation and maintenance of CSCs. Hence, identifying CSCs and targeting epigenetic pathways therein can offer new insights into the treatment of cancer. In the present review, recent studies are addressed in terms of the characteristics of CSCs, the resistance thereof, and the factors influencing the development thereof, with an emphasis on different types of epigenetic changes in genes and main signaling pathways involved therein. Finally, targeted therapy for CSCs by epigenetic drugs is referred to, which is a new approach in overcoming resistance and recurrence of cancer.
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Affiliation(s)
| | - Khatereh Khorsandi
- Department of Photodynamic, Medical Laser Research Center, Yara Institute, ACECR, Tehran, Iran.
| | - Azhar Rasul
- Department of Zoology, Government College University Faisalabad, Faisalabad, 38000, Pakistan
| | - Muhammad Khatir Zaman
- Department of Biotechnology, Abdul Wali Khan University Mardan (AWKUM), Mardan, 23200, Pakistan
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Abstract
The crystal structure of gliclazide, N-[(perhydrocyclopenta [c]pyrrol-2-yl)aminocarbonyl]-p-toluenesulfonamide, C15H21B3O3S, a second-generation oral hypoglycemic agent, contains discrete molecules with normal molecular dimensions. Both of the five-membered fused rings adopt envelope conformations. The molecules are linked into chains by intermolecular hydrogen bonds involving amino-H atoms, with N...O separations of 2.967 (3) and 2.949 (3) A.
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Affiliation(s)
- M Parvez
- Department of Chemistry, University of Calgary, Alberta, Canada.
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Abstract
A 39-year-old man with AIDS presented with cough, chest pain, dyspnea on exertion, fever, and a cavitary lesion in the upper lobe of the left lung. The cavity increased in size over the next five months with disease involvement limited to the left upper lobe. Pneumocystis carinii infection was then diagnosed. Symptoms and cavity resolved with trimethoprim/sulfamethoxazole therapy.
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Affiliation(s)
- V Chechani
- Pulmonary Section, Brooklyn VA Medical Center, NY
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Abstract
Pneumocystis carinii organisms cluster in alveolar casts. A method for concentrating alveolar casts in sputum specimens might improve the diagnostic usefulness of sputum studies in possible cases of pulmonary infection with Pneumocystis carinii. The use of sputum induction to detect Pneumocystis carinii was studied in 40 consecutive patients with known or suspected human immunodeficiency virus infection having bronchoscopy for evaluation of pulmonary disease. Sputum produced by deep coughing induced by 3% saline via a jet nebulizer was liquefied with dithiothreitol, and cells were sedimented and stained. Liquefaction of mucus allowed concentration of alveolar casts where P. carinii cysts were readily identified. A total of 28 patients were found to have P. carinii, which was detected in concentrated sputum in 21 of 38 patients, unconcentrated sputum in 10 of 38 patients, and by bronchoscopy in 25 of 37 patients. Sensitivity of concentrated sputum compared with bronchoscopy was 78% (95% CI, 58 to 90), with a negative predictive value of 71% (95% CI, 47 to 87). Values for unconcentrated sputum were 43% (95% CI, 25 to 63) and 48% (95% CI, 30 to 67), respectively. Liquefaction of adequately induced sputum facilitates processing and interpretation and increases yield for P. carinii, eliminating the need for invasive procedures in most patients.
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Affiliation(s)
- M K Zaman
- Brooklyn Veterans Administration Medical Center, New York
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Zaman MK, White DA. Serum lactate dehydrogenase levels and Pneumocystis carinii pneumonia. Diagnostic and prognostic significance. Am Rev Respir Dis 1988; 137:796-800. [PMID: 3258483 DOI: 10.1164/ajrccm/137.4.796] [Citation(s) in RCA: 137] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The level of serum lactate dehydrogenase (LDH) has been reported to be useful as a marker of Pneumocystis carinii pneumonia (PCP) in patients infected with the human immunodeficiency virus (HIV). In this study, we evaluated the clinical role of measurements of LDH in determining diagnosis and prognosis in 84 patients infected with HIV who presented with pulmonary problems. The mean serum LDH level of the 54 patients with PCP was 361 IU, which was significantly higher than the mean of 224 IU found in the 30 patients with other causes of pulmonary disease (p less than 0.001). Overlap of individual values occurred between the 2 groups. Levels greater than 450 IU consistently predicted PCP in our population, however, and normal values were found in only 7% of the patients with PCP. LDH levels in a group of 8 patients who developed PCP from conventional causes of immunosuppression were similar to those seen in PCP associated with HIV. LDH determinations prior to the episode of PCP were available in 45 patients and 39 (87%) showed an increase of greater than 50 IU at the time of diagnosis. The mean LDH in those who survived PCP was 340 IU, which was significantly less than the mean of 447 IU found in those who died (p less than 0.05). Significant overlap between the groups precluded use of the LDH as a predictor of mortality in an individual patient. Serial determinations of LDH during treatment for PCP showed that 27 of 36 (75%) of the survivors had gradual decreases of LDH, whereas 9 of 12 (75%) nonsurvivors had rising values during treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M K Zaman
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
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Gagliardi AJ, Stover DE, Zaman MK. Endobronchial Pneumocystis carinii infection in a patient with the acquired immune deficiency syndrome. Chest 1987; 91:463-4. [PMID: 3493122 DOI: 10.1378/chest.91.3.463] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We report a case of endobronchial Pneumocystis carinii infection in a patient who most likely had the acquired immune deficiency syndrome (AIDS). Although many unusual manifestations of Pneumocystis pneumonia have been reported in patients with AIDS, this is the first case of P carinii presenting as an endobronchial mass.
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