Karapitiya Teaching Hospital located in Karapitiya, Galle is the largest Tertiary care centre in the Southern Province of Sri Lanka. It was established in 1982 and is the main training facility for the Faculty of Medicine, University of Ruhuna. The hospital consists of 1,624 beds, 54 wards and several other units. It is the third largest tertiary care hospital in the country. Karapitiya Hospital meets the health needs of people in Southern Province and also provides services to the people of the surrounding areas..
BACKGROUND:Blood-pressure reduction is the only proven treatment to prevent stroke. Whether a single pill that combines three antihypertensive drugs at low doses, in addition to standard antihypertensive treatment, can lower blood pressure more than standard care alone and reduce the risk of recurrent stroke after intracerebral hemorrhage is uncertain. METHODS:We conducted a multinational, double-blind, randomized, placebo-controlled trial involving patients with a history of intracerebral hemorrhage. Patients were eligible for the trial if they had a systolic blood pressure of 130 to 160 mm Hg at baseline and were in clinically stable condition. After a 2-week active run-in phase during which all the patients received a once-daily pill containing three antihypertensive agents at low doses (telmisartan at 20 mg, amlodipine at 2.5 mg, and indapamide at 1.25 mg; the triple pill), the patients were randomly assigned to continue receiving the triple pill or to receive matching placebo. The primary outcome was the first recurrent stroke. Secondary outcomes included blood-pressure control, major cardiovascular events, death from cardiovascular causes, and safety. RESULTS:Of 1670 patients who underwent randomization, 833 were assigned to receive the triple pill and 837 to receive placebo. The mean age of the patients was 58 years. At a median follow-up of 2.5 years, recurrent stroke had occurred in 38 patients (4.6%) in the triple-pill group and 62 (7.4%) in the placebo group (hazard ratio, 0.61; 95% confidence interval [CI], 0.41 to 0.92; P = 0.02). The mean systolic blood pressure during follow-up was 127 mm Hg and 138 mm Hg, respectively. The incidence of major cardiovascular events was lower with the triple pill than with placebo (6.6% vs. 9.8%; P = 0.04). Serious adverse events occurred in 23.2% of the patients in the triple-pill group and 26.0% of those in the placebo group. Early discontinuation of the trial regimen due to an adverse event occurred in 13.6% and 6.0%, respectively. The most common adverse event leading to discontinuation was an increase of 20% or more in the serum creatinine level. CONCLUSIONS:Among patients with intracerebral hemorrhage, treatment with a combination of three low-dose antihypertensive agents in a single pill, in addition to standard care, was associated with a lower incidence of recurrent stroke and major cardiovascular events than placebo. (Funded by the National Health and Medical Research Council of Australia and the Brazilian Ministry of Health; TRIDENT ClinicalTrials.gov number, NCT02699645; Australian New Zealand Clinical Trials Registry number, ACTRN12616000327482.).
Diabetic kidney disease (DKD) is a major global burden, especially in Asia. This study aimed to evaluate the efficacy and safety of finerenone in diabetic kidney disease, comparing outcomes between Asian and non-Asian populations through a systematic review and meta-analysis. A systematic search was conducted across PubMed, Cochrane Library, ClinicalTrials.gov, Google Scholar, and the Undermind AI platform from inception through March 2025. Studies included randomized controlled trials (RCTs) and subgroup analyses that evaluated finerenone in DKD patients. Primary outcomes included a reduction in the urinary albumin-to-creatinine ratio (UACR) and a decline in the estimated glomerular filtration rate (eGFR) of ≥40
IntroductionTo further advance our understanding of Muscular Dystrophies (MDs) and Spinocerebellar Ataxias (SCAs), it is necessary to identify the biological patterns associated with disease pathology. Although progress has been made in the fields of genetics and transcriptomics, there is a need for proteomics and metabolomics studies. The present study aimed to be the first to document serum metabolic signatures of MDs (DMD, BMD, and LGMD 2A) SCAs (SCA 1-3), from a South Asian perspective.MethodsA total of 28 patients (SCA 1-10, SCA 2-2, SCA 3-2, DMD-10, BMD-2, LGMD-2) and eight controls (aged 8–65 years) were included. Metabolomic analysis was performed by Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy (UPLC-MS/MS), with support from the Houston Omics Collaborative.Results and discussionAmino acid metabolism was the primary altered super pathway in DMD followed by carbohydrate metabolism and lipid metabolism. In contrast, BMD and LGMD 2A exhibited a more prominent alteration in lipid metabolism followed by amino acid metabolism. In SCAs, primarily lipid, amino acid, peptide, nucleotide, and xenobiotics pathways are affected. Our findings offer new insights into the variance of metabolite levels in MD and SCA, with substantial implications for pathology, drug development, therapeutic targets and clinical management. Intriguingly, this study identified two novel metabolites associated with SCA. This pilot cross-sectional study warrants further research involving larger groups of participants, to validate our findings.
الخلاصة : الخلفية: بروتين هيكلي خلوي خاص بالخلايا العصبية يطلق عليه سلسلة الخيوط العصبية الخفيفة يقع في سايتوبلازم المحاور المغلفة بالمايلين خصوصا تلك التي لديها قطر كبير ويكون ضرورياً للحفاظ عبى حجم هذه المحاور ويوفر دعم هيكلي لها .ترتبط الشيخوخة و اضطرابات وظائف الكلى, امراض الكبد, الاعتلالات العصبية و مرض السكري بارتفاع مستويات سلسلة الخيوط العصبية الخفيفة في مص الدم. وتعتبر علامة حيوية غير جراحية يمكن ان تساعد في تشخيص اعتلال الاعصاب المتعدد المتناظرالبعيد و ربما التنبأ بمساره . الاهداف : تقييم مستوتات سلسلة الخيوط العصبية الخفيفة في امصال مرضى السكري الذين يعانون من الاعتلال الاعصاب المتعدد المتماثل البعيد ومقارنه مستوياته مع مرضى السكري الذين لا يعانون من اعتلال الاعصاب المتعدد المتناظرالبعيد باستخدام دراسة الاعصاب ونظام النقاط للتحري التحري مشيغان. المواد والطرق : شارك 126 مريض من الذكور والاناث الذين يعانون من مرض السكري النوع الثاني في هذه الدراسة المقطعية التي امتدت من نهاية عام 2022 الى منتصف عام 2023 في مركز السكري التابع للجامعه المستنصرية.بعد الحصول على الموافقة اللفظية, تم تقييم الوظائف الاعصاب الطرفية للمرضى الخاضعين للدراسة وتم احتساب مؤشر كتلة الجسم باستخدام طولهم و وزنهم. تم تحديد مستويات جميع انواع الدهنيات و سلسلة الخيوط العصبية الخفيفة في المصل . تم استخدام المعادلات لحساب VLDL و LDL . النتائج : اظهرت هذه الدراسة عدم وجود تغيير في مستويات مصل سلسلة الخيوط العصبية الخفيفة عند مقارنة المرضى الذين يعانون من اعتلال الاعصاب المتعدد المتناظر البعيد وبدونه. بالاضافة الى ذلك, لم يتم العثور على اي تغير بناءأ على درجات فحص المرضى مشيغان . الكلمات المفتاحية: الخيوط العصبية الخفيفة, اعتلال الاعصاب المتعدد المتناظر البعيد, دراسة التوصيل العصبي, أداة فحص الاعتلال العصبي مشيغان .
