The present experiment was carried out from November 2017 to April 2018 i.e. during the winter and summer season at ICAR-National Dairy Research Institute, Karnal (Haryana) to investigate the effect of supplementation of Lactobacillus plantarum CRD 2 and Lactobacillus rhamnosus CRD 9 probiotic cultures on physiological responses in Murrah buffalo calves. The new born Murrah buffalo calves were divided into four groups viz., T1, T2, T3, and T4. The calves of control group (T1) were fed according to ICAR, 2013 feeding standard. Calves of T2 were fed according to control group (T1) except Lactobacillus plantarum CRD 2 supplementation 108 cfu/ml (As fermented milk @ 100 ml/calf/day). The calves T3 were fed according to control group (T1) except Lactobacillus rhamnosus CRD 9 supplementation 108 cfu/ml (As a fermented milk @ 100 ml/calf/day), also the calves of T4 fed according to control group (T1) except combination of Lactobacillus plantarum CRD 2 and Lactobacillus rhamnosus CRD 9 108 cfu/ml [1:1 Ratio] (As a fermented milk @ 100 ml/calf/day) supplementation. During the winter season the overall mean± SE values of maximum and minimum temperature were 21.49±0.88 and 08.18±0.85 respectively while during the summer season the overall mean± SE values of maximum and minimum temperature were 30.22±1.74 and 13.45±1.38 respectively. The mean temperature-humidity index (THI) at morning and afternoon sessions during the winter season were 58.49±1.43 and 60.54±3.45 respectively while 75.07±1.72 and 59.20±1.29 respectively during the summer seasons. There were no significant (P<0.05) differences observed inrectal temperature, respiration rate and pulse ratebetween different treatment groups at the morning and afternoon session during the winter as well as summer season also during the pre-ruminant as well as post-ruminant phase while the rectal temperature, respiration and pulse rate in buffalo calves at afternoon session was slightly higher in all groups during the winter as well as summer season.There were also no significant (P<0.05) differences observed inrectal temperature, respiration rate and pulse ratebetween different treatment groups of female and male buffalo calves in the morning as well as afternoon session. The rectal temperature and respiration rate of treatment groups in the morning and at afternoon session in the both sexes was slightly lower than control group. The all observation were falls in the normal physiological range so these findings indicated that probiotic supplementation had no adverse effect on physiology of calves resulted in normalphysiological responses in buffalo calves, so probiotic supplementation advantageous in the removal of stress in the young buffalo calves during the stress period which are more prone to cold as well as heat stress.

https://www.phytojournal.com/archives/2019/vol8issue2/PartAD/8-2-419-202.pdf

Effect of supplementation of Lactobacillus plantarum CRD 2 and Lactobacillus rhamnosus CRD 9 probiotic cultures on physiological responses in Murrah buffalo calves

Evidence from clinical research indicates that men and women can differ in response to drug treatment. The knowledge database Janusmed Sex and Gender was developed to illuminate potential sex and gender differences in drug therapy and, therefore, achieve a better patient safety. The database contains non-commercial evidence-based information on drug substances regarding sex and gender aspects in patient treatment. Here, we describe our experiences and reflections from collecting, analyzing, and evaluating the evidence.Substances have been systematically reviewed and classified in a standardized manner. The classification considers clinically relevant sex and gender differences based on available evidence. Mainly biological sex differences are assessed except for gender differences regarding adverse effects and compliance. Of the 400 substances included in the database, clinically relevant sex differences were found for 20%. Sex-divided data were missing for 22% and no clinically relevant differences were found for more than half of the substances (52%). We noted that pivotal clinical studies often lack sex analyses of efficacy and adverse effects, and post-hoc analyzes are performed instead. Furthermore, most pharmacokinetic analyses use weight correction, but medicines are often prescribed in standard doses. In addition, few studies have sex differences as a primary outcome and some pharmacokinetic analyses are unpublished, which may complicate the classification of evidence.Our work underlines the need of sex and gender analyses, and sex-divided data in drug treatment, to increase the knowledge about these aspects in drug treatment and contribute to a more individualized patient treatment. 

/pdf/sex-and-gender-differences-in-drug-treatment-experiences-sla55gjs.pdf

Sex and gender differences in drug treatment: experiences from the knowledge database Janusmed Sex and Gender

Cardiovascular disease (CVD) during pregnancy varies significantly worldwide, influenced by factors such as access to healthcare, delayed diagnosis, causes, and risk factors. Our study sought to explore the spectrum of CVD present in pregnant women in the United Arab Emirates to better understand this population’s unique needs and challenges. Central to our study is an emphasis on the importance of implementing a multidisciplinary approach that involves the collaboration of obstetricians, cardiologists, geneticists, and other healthcare professionals to ensure that patients receive comprehensive and coordinated care. This approach can also help identify high-risk patients and implement preventive measures to reduce the occurrence of adverse maternal outcomes. Furthermore, increasing awareness among women about the risk of CVD during pregnancy and obtaining detailed family histories can help in the early identification and management of these conditions. Genetic testing and family screening can also aid in identifying inherited CVD that can be passed down through families. To illustrate the significance of such an approach, we provide a comprehensive analysis of five women’s cases from our retrospective study of 800 women. The findings from our study emphasize the importance of addressing maternal cardiac health in pregnancy and the need for targeted interventions and improvements in the existing healthcare system to reduce adverse maternal outcomes.

/pdf/introducing-and-implementing-genetic-assessment-in-cardio-8f1jkam0.pdf

Introducing and Implementing Genetic Assessment in Cardio-Obstetrics Clinical Practice: Clinical and Genetic Workup of Patients with Cardiomyopathy

Abstract Purpose Several studies link maternal cardiovascular disease (CVD) to maternal and fetal morbidity and mortality. This study describes the profile of maternal, obstetric, and neonatal outcomes among pregnant women with CVD in a tertiary hospital in the Philippines. It identifies the clinical and sociodemographic variables associated with these outcomes. Materials and Methods A single-center, retrospective analysis of pregnant women admitted for delivery at the Philippine General Hospital from 2015 to 2019 was performed. Of these patients, pregnant women with CVD were identified as the cohort for this study. Data on clinical and sociodemographic factors, maternal major adverse cardiovascular events, neonatal adverse clinical events, and obstetric complications were collected. Logistic regression analysis was performed to determine the odds ratio for the risk factors for small-for-gestational-age (SGA) babies and preterm birth. Results Among 30,053 delivery admissions in the Philippine General Hospital from 2015 to 2019, 293 (0.98%) pregnant women had CVD. Of the CVDs present in this cohort, congenital heart diseases (n = 119, 40.6%) were the most common, followed by rheumatic heart disease (n = 109, 37.2%). Maternal adverse events were rarely observed. Four women experienced symptomatic arrhythmias, two presented with worsening heart failure, three experienced thromboembolic events, and one had cerebrovascular infarction. There was no reported maternal death, cardiac arrest, shock, or acute renal failure. The majority (69.3%) of the women included in the study were delivered by spontaneous vaginal delivery and assisted vaginal delivery by vacuum or forceps; however, a significant portion of these women had undergone cesarean section. Almost all the study cohort delivered live births, with most neonates being delivered at 37–38 weeks gestational age (83.6%) and only 16.0% born preterm. However, a significant portion, a third of the neonates, were classified as having low birth weight. Around 17.4% of neonates born from gravidocardiac mothers were admitted neonatal intensive care unit. Conditions associated with preterm birth were low educational attainment, previous history of early neonatal death, maternal low ejection fraction, and abnormal maternal left ventricular geometry. The conditions associated with SGA babies were high gravidity and parity, a history of abortion/stillbirth, a history of previous cesarean section delivery, low ejection fraction, a history of multiple gestations, and higher BMI. Conclusion In this cohort study, adverse maternal outcomes were rarely observed. CVD in pregnancy is associated with an increased risk of preterm birth and SGA babies. We identified certain maternal conditions and sociodemographic factors associated with these outcomes. Despite having CVD, our study cohort had no mortality from the pregnancy.

https://figshare.com/articles/journal_contribution/Maternal_and_neonatal_outcomes_among_pregnant_women_with_cardiovascular_disease_in_the_Philippines_a_retrospective_cross-sectional_study_from_2015_2019/19921643/1/files/35402045.pdf

Maternal and neonatal outcomes among pregnant women with cardiovascular disease in the Philippines: a retrospective cross-sectional study from 2015–2019

Pulse rate, respiration, and body temperature of Philippine carabaos

In patients with heart failure (HF), randomized controlled trials (RCTs) of sodium-glucose transporter-2 inhibitors (SGLT-2is) have proven to be effective in decreasing the primary composite outcome of cardiovascular death and hospitalizations for HF. A recently published meta-analysis showed that the use of SGLT-2is among women with diabetes resulted in less reduction in primary composite outcomes compared with men. This study aims to explore potential sex differences in primary composite outcomes among patients with HF treated with SGLT-2is.We systematically searched the medical database from 2017 to 2022 and retrieved all the RCTs using SGLT-2is with specified cardiovascular outcomes. We used the PRISMA (Preferred Reporting Items for a Review and Meta-analysis) method to screen for eligibility. We evaluated the quality of studies using the Cochrane Risk of Bias tool. We pooled the hazard ratio (HR) of the primary composite outcomes in both sexes, performed a meta-analysis, and calculated the odds ratio (OR) of the primary composite outcomes based on sex.We included 5 RCTs with a total number of 21,947 patients. Of these, 7837 (35.7 %) were females. Primary composite outcomes were significantly lower in males and females taking SGLT-2is compared to placebo (males - HR 0.77; 95 % CI 0.72 to 0.84; p = 0.00001; females - HR 0.75; 95 % CI 0.67 to 0.84; p = 0.00001). Pooled data from four of the RCTs (n = 20,725) revealed a greater occurrence of the primary composite outcomes in females compared with males (OR 1.32; 95 % CI 1.17 to 1.48; p = 0.0002).SGLT-2is reduce the risk of primary composite outcomes in patients with HF, regardless of sex; however, the benefits were less pronounced in women. Further research needs to be done to better explain these observed differences in outcomes. 

https://doi.org/10.1016/j.ahjo.2023.100261

Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis

BACKGROUND
Transcatheter Aortic Valve Replacement (TAVR) is a relatively novel minimally invasive procedure for the treatment of symptomatic patients with severe aortic stenosis. Although it has been proven effective in improving mortality and quality of life, TAVR is associated with serious complications, such as acute kidney injury (AKI).


SUMMARY
TAVR-associated AKI is likely due to several factors such as sustained hypotension, transapical approach, volume of contrast use and baseline low GFR. This narrative review aims to present an overview of the latest literature and evidence regarding the definition of TAVR-associated AKI, its risk factors, and its impact on morbidity and mortality. The review used a systematic search strategy with multiple health-focused databases (Medline, EMBASE), and identified 8 clinical trials and 27 observational studies concerning TAVR-associated AKI. Results showed that TAVR-associated AKI is linked to several modifiable and non-modifiable risk factors, and is associated with higher mortality. A variety of diagnostic imaging modalities have the potential to identify patients at high-risk for development of TAVR-AKI; however, there are no existing consensus recommendations regarding their use as of this time. The implications of these findings highlight the importance of identifying high-risk patients for which preventive measures may play a crucial role, and should be maximized.


KEY MESSAGE
This study reviews the current understanding of TAVR-associated AKI including its pathophysiology, risk factors, diagnostic modalities, and preventative management for patients.

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Transcatheter Aortic Valve Replacement (TAVR)-associated Acute Kidney Injury: An Update.

BACKGROUND
Aortic stenosis (AS) can present with dyspnea, angina, syncope, and palpitations and this presents a diagnostic challenge as chronic kidney disease (CKD) and other commonly found comorbid conditions may present similarly. While medical optimization is an important aspect in management, aortic valve replacement (AVR) by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) is the definitive treatment. Patients with concomitant CKD and AS require special consideration as it is known that CKD is associated with progression of AS and poor long-term outcomes.


AIMS AND OBJECTIVES
To summarize and review current existing literature on patients with both CKD and AS regarding disease progression, dialysis method, surgical intervention, and post operative outcomes.


CONCLUSION
The incidence of aortic stenosis increases with age but has also been independently associated with chronic kidney disease and furthermore with hemodialysis. Regular dialysis with hemodialysis vs. peritoneal dialysis and female gender have been associated with progression of AS. Management of aortic stenosis is multidisciplinary and requires planning and interventions by the "Heart-Kidney Team" to decrease risk of further inducing kidney injury among high-risk population. Both TAVR and SAVR are effective interventions for patients with severe symptomatic AS, but TAVR has been associated with better short-term renal and cardiovascular outcomes.


IMPLICATIONS FOR PRACTICE
Special consideration must be taken in patients with both CKD and AS. The choice of whether to undergo hemodialysis (HD) vs. peritoneal dialysis (PD) among patients with CKD is multifactorial but studies have shown benefit regarding AS progression among those who undergo PD. The choice regarding AVR approach is likewise the same. TAVR has been associated with decreased complications among CKD patients, but the decision is multifactorial and requires a comprehensive discussion with the Heart-Kidney Team as many other factors play a role in the decision including preference, prognosis, and other risk factors.

/pdf/aortic-stenosis-and-aortic-valve-replacement-among-patients-2nbct5gk.pdf

F. B. Rivera

Papers

Maternal and neonatal outcomes among pregnant women with cardiovascular disease in the Philippines: a retrospective cross-sectional study from 2015–2019

Pulse rate, respiration, and body temperature of Philippine carabaos

Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis

Transcatheter Aortic Valve Replacement (TAVR)-associated Acute Kidney Injury: An Update.

Aortic Stenosis and Aortic Valve Replacement Among Patients with Chronic Kidney Disease: A Narrative Review.