Tolvaptan in Hyponatremia ; Acute MI and Coronary intervention strategies

Tolvaptan, an orally active vasopressin V₂-receptor antagonist in management of euvolemic or hypervolemic hyponatremia:

    Euvolemic (caused by SIADH, Water intoxication syndrome, Responce to heightened emotional or pain stimuli, Hypothyroidism, Corticosteroid deficiency)   or Hypervolemic (caused by CHF, Cirrhosis of liver, Nephrosis, Renal failure) hyponatremia is a commonly encountered problem in in-patient settings. Currently, no effective therapy is available to treat such patients (Current Management modalities and adverse events: water deprivation, careful administration of hypertonic saline; pontine and extrapontine myelinolysis are potential hazards if correction occurs too rapidly)

    Recently conducted two RCTs suggested efficacy of tolvaptan  in patients with euvolemic or hypervolemic hyponatremia in increasing serum sodium concentrations at day 4 and day 30. (ClinicalTrials.gov numbers, NCT00072683 [SALT-1] and NCT00201994 [SALT-2].) However, recurrence of hyponatremia was noted in a week after discontinuation of tolvaptan on day 30. Tolvaptan - an orally active vasopressin V₂-receptor antagonist promotes aquaresis - excretion of electrolyte-free water. Read early release article at NEJM November 14, 2006 (10.1056/NEJMoa065181)

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Other articles of interest in same issue are related to Acute Myocardial Infarction and Coronary intervention strategies:
Myocardial Infarction and the Open-Artery Hypothesis
Treatment of Coronary In-Stent Restenosis with a Paclitaxel-Coated Balloon Catheter
Treatment of In-Stent Restenosis — Back to the Future?
Reducing the Door-to-Balloon Time for Myocardial Infarction with ST-Segment Elevation
Coronary Intervention for Persistent Occlusion after Myocardial Infarction

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Activated protein C (Xigris) in CV Stroke; Eye in Cerebral Malaria

Eye as a diagnostic tool for Cerebral Malaria:
The eye can provide a very reliable way of diagnosing cerebral malaria, researchers in Malawi have shown. Cerebral malaria is accompanied by changes in the retina, the light-sensitive tissue at the back of the eye. These changes, known as malarial retinopathy, include white, opaque patches, whitening of the infected blood vessels, bleeding into the retina and swelling of the optic nerve. The first two of these signs are unique to severe malaria, and not seen in any other disease. [EurekAlert! link]

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Tonsils and Streptococcal Infection:
Children with recurrent strep throat whose tonsils have not been removed are over three times more likely to develop subsequent episodes of strep throat than children who undergo tonsillectomy, according to a Mayo Clinic study published in the Nov. 2 issue of Laryngoscope. [EurekAlert! link]

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Activated protein C (APC - Xigris^®): New drug to watch for in CV Stroke
After a decade long of TPA use - only available treatment for CV Stroke, now doctors and scientists at the University of Rochester Medical Center have developed a potential new treatment that can be breakthrough in the next few months, when FDA approved trial of treating 72 patients of CV stroke in four communities around the nation, including Rochester in next few months. Currently, APC is indicated in adults with severe sepsis with high risk of death. APC offers a potential way to temper the side effects of TPA and to increase the treatment "window" beyond three hours. Zlokovic and colleagues have demonstrated that APC protects brain cells that are under siege in multiple ways. In the laboratory, Zlokovic and colleagues have shown that APC counters a great deal of this damage, saving most of the brain cells that otherwise die and reducing the impact of stroke by 70 percent. His team first showed that TPA itself can kill neurons and amplify a stroke, then demonstrated that APC protects brain cells from the toxic effects of TPA and slows down the cascade of signals that causes more brain cells to die. They've also shown that APC helps quell inflammation.....

If you wish to know in detail about this exciting drug tiral, please visit follwing links:

1. EurekAlert! News (2-Nov-2006): Doctors launch new effort to treat stroke more effectively
2. Nature Medicine November issue (upcoming)
3. Activated protein C (Xigris^®)

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