Vitamin D: a cardioprotective agent?

Vitamin D is a fat-soluble vitamin that is naturally found in very few foods, is added to others, and is available as a dietary supplement. It is produced endogenously when ultraviolet light strikes the skin. Recent epidemiologic and experimental evidence has suggested that low vitamin D levels may play a role in various cardiovascular conditions, including coronary artery disease, congestive heart failure, valvular calcification, stroke, hypertension, and cognitive decline. Low vitamin D may lead to vascular smooth muscle cell proliferation, endothelial cell dysfunction, vascular and myocardial cell calcification, and increased inflammation. However, the data supporting a cardioprotective effect of vitamin D supplementation are very weak, and the large, controlled clinical trials now in progress should resolve this issue.     

Can either oral glucose challenge test or oral glucose tolerance test parameters predict gestational diabetes mellitus?

This study aims to evaluate the relationship between the glucose challenge test (GCT) levels and any of the oral glucose tolerance test (OGTT) parameters (fasting plasma glucose (FPG), 1-, 2-, or 3-h plasma glucose levels) and their effect on predicting gestational diabetes mellitus (GDM). This analysis was carried out as a retrospective study at Obstetrics and Gynecology Clinic of Turgut Özal University Hospital. Oral GCT were conducted on patients who are at 24–29 weeks’ gestation. The study participants with positive GCT results underwent a 3-h, 100-g OGTT, and the resulting values were evaluated using Carpenter and Coustan diagnostic criteria to determine the gestational glucose tolerance status of patients. The data obtained from both tests (GCT, FPG, 1-, 2-, 3-h OGTT values) were analyzed to observe the effect of each group on predicting GDM. Although all of the GCT and OGTT values were found to be statistically significant (p?<?0.001) in determining GDM, the 2-h values of OGTT detected almost all GDM cases with a very high sensitivity level (94.5 %). The 1-h values on the other hand identified 87.6 % of GDM (p?<?0.001). The GCT value with the highest sensitivity and specificity for predicting GDM was calculated as 154.50 mg/dl (sensitivity and specificity rates were 79.2 and 72.8 %, respectively). A 2-h OGTT glucose level can detect GDM with 94.5 % sensitivity. This result can guide clinicians to evaluate the patients with GDM.     

Will oral antithrombin agents replace warfarin?

The new oral direct thrombin inhibitor ximelagatran is at least equivalent to warfarin for stroke prevention in patients with non-valvar atrial fibrillation, and seems to be a promising adjunct to aspirin after acute coronary syndrome     

Should we monitor the direct oral anticoagulants?

Journal of Thrombosis and Thrombolysis -     

Recombinant factor VIIa: a universal hemostatic agent?

Recombinant factor VIIa (rVIIa) has proved effective for the treatment and prevention of hemorrhage in patients with inherited hemophilia A and B who develop inhibitors to factor VIII or IX, and patients with acquired hemophilia A. More recently, there is evidence that rVIIa may also be effective in the control of abnormal bleeding in a variety of other conditions, such as inherited factor VII deficiency, thrombocytopenia, Glanzmann's thrombasthenia, and liver disease. In some of the reports, rVIIa appeared to be effective in controlling massive hemorrhage in which there was no response to conventional measures. It is now considered by some to be potentially the first universal hemostatic agent. However, further prospective, controlled, and adequately powered clinical studies are clearly required. It will be of particular interest to determine the efficacy of rVIIa in conditions such as severe thrombocytopenia, severe von Willebrand disease, severe defects in platelet activation, and severe deficiencies of factors V, X, II, and fibrinogen in which effectiveness would seem to be unlikely based on our current understanding of mechanisms of action of rVIIa.