Efecto antiproliferativo renal del enalaprilato

Introducción: El enalapril es conocido por su efecto antiproliferativo, al inhibir la Enzima de Conversión de la Angiotensina I (IECA). Revierte efectos renales de la angiotensina II entre ellos la hiperfiltración glomerular pudiendo prevenir la esclerosis. Objetivo: Analizar efecto antiproliferativo del enalaprilato en modelo renal de esclerosis en ratas wistar. Material y Métodos: 20 ratas wistar fueron divididas en 4 grupos de 5. Grupo1: tratado con enalaprilato luego de nefrectomía. Grupo 2: enalaprilato previo a la nefrectomía. Grupo 3: nefrectomía sin tratamiento. Grupo 4: enalaprilato sin nefrectomía. Dosis fue de 60 mg/Kg/día por cánula orogástrica por 1 mes. Ratas fueron sacrificadas tomándose muestras histológicas de los riñones. Fueron evaluados tamaño y peso del riñón y estadificación por grado de la lesión glomerular. Los datos se muestran en promedio y DE, y por frecuencia y porcentaje. Resultados: 87% de las ratas sobrevivieron a la nefrectomía. El promedio general del tamaño renal fue de 20x10 mm y el peso renal del G1: 1,6 ±0. 1g; G2: 1,7±0,5g; G3:2,0±0,2g y G4:1,7±0,1g. El grado máximo de glomeruloesclerosis fue grado 1(expansión mensagial/ engrosamiento de la membrana basal y/o irregularidades de las luces de los capilares); el G1 presentó 50% de afectación, G2 presentó 25 %, G3 mostró 60% y G4 sin afectación glomerular. Conclusión: El enalaprilato previene el grado de glomeruloesclerosis en el grupo G2 demostrando que administrado antes de la nefrectomía la evolución de la esclerosis disminuye en relación al G1 y G3.Con esto podemos probar el efecto antiproliferativo del IECA

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Exploring Genetic Factors Involved in Huntington Disease Age of Onset: E2F2 as a New Potential Modifier Gene

Neurological Motor Disorder