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1.
Diltiazem versus metoprolol for the management of atrial fibrillation: A systematic review and meta-analysis.
Jafri, SH, Xu, J, Warsi, I, Cerecedo-Lopez, CD
The American journal of emergency medicine. 2021;:323-327
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2.
MEBO versus topical Diltiazem versus a combination of both ointments in the treatment of acute anal fissure: a randomized clinical trial protocol.
El Charif, MH, Doughan, S, Kredly, R, Kassas, S, Azab, R, Sbaity, E
BMC complementary medicine and therapies. 2021;(1):75
Abstract
BACKGROUND Anal fissure is a common complication of the anorectal region and one of the most reported causes of anal pain. Acute anal fissure can be cured by surgery or medical treatment. There is an increase in the use of topical therapy for the treatment of anal fissures. A common topical drug used is Diltiazem (DTZ), a calcium-channel blocker, which relaxes the anal sphincter and thus promotes healing of the anal fissure. Moist exposed burn ointment (MEBO) is an ointment that is effective for the treatment of burns and wound healing and is becoming popular in the treatment of anal fissures. METHODS This is a 1:1:1 randomized, controlled, parallel design, with endpoint measures of change in pain score, wound healing, defecation strain score and patient's global impression of improvement. The study will be conducted at AUBMC over a 10-week period. Patients will be randomized to three treatment arms: MEBO, Diltiazem, and a combination of MEBO and Diltiazem ointments. DISCUSSION The results of this study will allow physicians to assess the efficacy and safety of MEBO in the treatment of acute anal fissure, and also in comparison to Diltiazem. This trial will generate evidence-based conclusions regarding the use of a herbal/natural-based product (MEBO ointment) for the treatment of anal fissures. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04153032 . Clinical Trial Registration Date: 06-NOVEMBER-2019.
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3.
Magnesium sulfate or diltiazem as adjuvants to total intravenous anesthesia to reduce blood loss in functional endoscopic sinus surgery.
Aravindan, A, Subramanium, R, Chhabra, A, Datta, PK, Rewari, V, Sharma, SC, Kumar, R
Journal of clinical anesthesia. 2016;:179-85
Abstract
STUDY OBJECTIVE This study was designed to know whether addition of magnesium sulfate (MgSO4) or diltiazem to total intravenous anesthesia (TIVA) (propofol) aided reduction in blood loss during functional endoscopic sinus surgery (FESS). The secondary outcomes measured were surgeon's assessment of the surgical field and hemodynamics. DESIGN Randomized, double-blinded, placebo-controlled trial. SETTING Operating room. PATIENTS Forty-five American Society of Anesthesiologists I and II adult patients (18-60years) undergoing FESS. INTERVENTIONS All groups received propofol-fentanyl TIVA. Patients were randomly allocated to 1 of the 3 groups (MgSO4 group, n=15; diltiazem group, n=15; saline group, n=15). MEASUREMENTS Intraoperative bleeding was quantified, and quality of surgical field was graded. Hemodynamic parameters were recorded. MAIN RESULTS Addition of both MgSO4 and diltiazem significantly reduced blood loss (240 and 350mL) in comparison to control group (415mL) (P=.003). The surgical field was significantly better in the MgSO4 group compared with the diltiazem (P=.028) and saline groups (P=.0001). CONCLUSION It was concluded that the addition of both MgSO4 and diltiazem to TIVA propofol results in significant reduction in blood loss and significant improvement in the quality of surgical field during FESS without causing any adverse effects on the hemodynamics or on the recovery from anesthesia. The surgical field in the MgSO4 group was significantly better than that in the diltiazem group (P=.04).
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4.
Effects of diltiazem on sympathetic activity in patients with aneurysmal subarachnoid hemorrhage.
Ogura, T, Takeda, R, Ooigawa, H, Nakajima, H, Kurita, H
Acta neurochirurgica. Supplement. 2015;:47-50
Abstract
This study evaluated the effect of diltiazem, a calcium antagonist, on sympathetic activity in patients with aneurysmal subarachnoid hemorrhage (SAH) during the hyperacute stage. Of patients with aneurysmal SAH who underwent aneurysm repair between August 2008 and June 2011, 119 consecutive patients were enrolled in this prospective study. On admission, patients were assigned to an antihypertensive treatment receiving continuous infusion of diltiazem (67 patients) or nicardipine (52 patients). Plasma levels of adrenaline (AD), noradrenaline (NA), and dopamine (DP) were repeatedly measured using high-performance liquid chromatography (HPLC). There were no significant differences in patient characteristics or aneurysm topography between the two groups. In all patients, acute surge of catecholamines was observed with mutual correlation. However, patients receiving diltiazem exhibited a significantly lower plasma concentration of DP than those receiving nicardipine, 3 and 6 h after admission. A similar trend was observed for NA, but the difference was not significant at 6 h. Conversely, the concentration of AD was similar between the two groups. Diltiazem may suppress sympathetic activity in the hyperacute stage of aneurysmal SAH. Further studies are needed to verify the beneficial effect of diltiazem in patients with SAH.
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5.
Comparison of topical isosorbide mononitrate, topical diltiazem, and their combination in the treatment of chronic anal fissure.
Bulus, H, Varol, N, Tas, A, Coskun, A
Asian journal of surgery. 2013;(4):165-9
Abstract
BACKGROUND/OBJECTIVE Chronic anal fissure is a painful condition that is associated with an increase in internal anal sphincter pressure. The main aim of this study is to evaluate the efficacy and adverse effects of topical isosorbide 5 mononitrate and topical diltiazem, when administered either as single agents or in combination, in the treatment of anal fissure. METHODS Patients with chronic anal fissure were enrolled in the study. They were randomized into three groups: Group A (0.2% isosorbide 5 mononitrate users), Group B (2% diltiazem users), and Group C (2%diltiazem + 0.2% isosorbide 5 mononitrate users). Pain was evaluated using a visual analog scale (VAS). Level of strain during defecation was graded on a 4-point scale. RESULTS A total of 55 patients were enrolled in the study. The average ages of patients in Groups A, B, and C were 37.94 ± 16.19, 42.83 ± 13.21, 40 ± 13.58 years, respectively. After treatment, pain completely abated in 55.6% of patients in Group A, 27.8% (n = 5) in Group B, and 42.1% (n = 8) in Group C. The decreases in average VAS values prior to and after treatment in Groups A, B, and C were statistically significant (p values 0.0001, 0.001, and 0.0001, respectively). Average strain scores prior to and after treatment were 2.11/0.72 for Group A, 2.17/0.94 for Group B, and 1.95/0.47 for Group C. Strain during defecation prior to and after treatment in Groups A, B, and C was statistically significant (p values 0.001, 0.001, and 0.003, respectively). CONCLUSION Topical diltiazem and a combination of nitrate and diltiazem can be used in the treatment of anal fissure. However, the agents are not significantly superior each other.
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6.
Calcium channel blocker (diltiazem) inhibits apoptosis of vascular smooth muscle cell exposed to high glucose concentration through lectin-like oxidized low density lipoprotein receptor-1 (LOX-1) pathway.
Rudijanto, A
Acta medica Indonesiana. 2010;(2):59-65
Abstract
AIM: to examine the role of diltiazem in the prevention of VSMC apoptosis exposed to high glucose through inhibition of LOX-1 expression. METHODS we performed experimental study on the primary culture of VSMCs. Expression LOX-1, and Caspase-3 activity (a key regulatory protease at which many signaling pathways merge for the execution of apoptosis) were measured by Elisa. Data were expressed as mean ± SEM. The statistical significance was assessed by one-way analysis of variance (ANOVA) followed by post hock analysis by Turckey test, p<0.05 was considered statistically significant. RESULTS chronic exposed VSMC to high glucose concentration (25 mM), increase cytosolic Ca++ concentration (3127 ± 413.89 v.s. 2011.81 ± 410.93 unit/cell, p<0.01), expression of LOX-1 ((506.80 ± 10.47 v.s. 458.40 ± 36.49 ng/ml, p<0.05), and caspase-3 activity (129.98 ± 5.97 v.s. 114.73 ± 10.84%, p<0.05) respectively, compare exposed to 5mM glucose concentration. LOX-1 was related to caspase-3 activity, pre-treated with inhibitor LOX-1 activity, k-carragenan before being exposed to glucose 25 mM, prevents the increasing of caspase-3 activity (96.41 ± 5.11 v.s. 129.98 ± 5.98 %, p<0.01). Pre incubation with 10μM of diltiazem before being exposed to 25 mM glucose concentration significantly inhibits the elevation of cytosolic Ca++ concentration (2149.61 ± 339.49 v.s. 3127 ± 413.89 unit/cell, p<0.01), LOX-1 expression (468,60 ± 14.44 v.s. 506.80 ± 10.47 ng/ml, p < 0.05), and caspase-3 activity (82.50 ± 9.90 v.s. 129.98 ± 5.97%, p<0.01). CONCLUSION overall, these results demonstrate that high glucose induces VSMCs apoptosis through caspase-3 pathway. This effect appears to be inhibited by diltiazem through decreasing LOX-1 expression and activity.
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7.
Long-term prospective randomised clinical and manometric comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure.
Abd Elhady, HM, Othman, IH, Hablus, MA, Ismail, TA, Aboryia, MH, Selim, MF
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie. 2009;(4):112-4
Abstract
AIM: To compare surgical and chemical sphincterotomy for treatment of chronic anal fissure. METHODS The 160 patients studied were randomly divided into four equal groups, treated by lateral internal sphincterotomy (group S), local diltiazem ointment (group D), local glyceryl trinitrate ointment (group GTN), or injection of botulinum toxin into the internal anal sphincter (group BT). Anal manometry was performed before and 3 months after treatment. Patients were followed up for 5 years. RESULTS Complete pain relief was achieved in means (+/- standard deviation) of 5.7+/-7.8 days (group S), 15.7+/-5.9 days (group D), 15.6+/-5.9 days (group GTN) and 2.7+/-3.6 days (group BT). The mean times to healing were 4.5+/-1.2 weeks (group 1), 5.1+/-1.1 weeks (group D), 5.0+/-1.1 weeks (group GTN) and 5.1+/-1.3 weeks (group BT). Mean resting and squeeze anal pressures decreased significantly after sphincterotomy. Recurrence rates were 10% in group S, 65% in group D, 57.5% in group GTN and 52.5% in group BT. CONCLUSION Lateral internal sphincterotomy is an easy procedure with satisfactory results, minimal complications and a low recurrence rate. Medical sphincterotomy is safe and easy, with mild complications. Its effect is reversible, and relapse is common. We recommend that medical sphincterotomy be tried before surgery or in patients who are unable or unwilling to undergo surgery.
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8.
No gender-associated differences of cyclosporine pharmacokinetics in stable renal transplant patients treated with diltiazem.
Aros, CA, Ardiles, LG, Schneider, HO, Flores, CA, Alruiz, PA, Jerez, VR, Mezzano, SA
Transplantation proceedings. 2005;(8):3364-6
Abstract
Cytochrome-P450 enzymes metabolize cyclosporine both in the liver and in the intestinal wall. Diltiazem, by competitive inhibition of these enzymes, may increase the absorption and the bioavailability of cyclosporine. Some evidence points to a higher activity of some specific enzymes in women, such as CYP3A, that may influence differences in cyclosporine pharmacokinetics. We examined possible gender-associated differences in pharmacokinetic profiles of cyclosporine in 19 stable renal transplant recipients cotreated with diltiazem. Ten women and nine men, chronically using diltiazem associated with cyclosporine, azathioprine, and prednisone were randomly assigned to an 8-week period of continued controlled treatment with diltiazem (10 patients) or a wash-out period discontinuing diltiazem (nine patients). At the end of this period, the time-concentration curves of cyclosporine in the first 4 hours were performed after a single dose of cyclosporine. Thereafter, a cross-over between groups was performed, and time-concentration curves repeated. A specific RIA was used to measure cyclosporine concentrations. Comparisons between male and female patients in doses of cyclosporine and other pharmacokinetics parameters (C(0), C(2), AUC(0-4)), with or without diltiazem, did not show any difference related to gender. The association of diltiazem allowed a similar degree of reduction in Neoral dosage in male and female patients (21%). No changes in serum creatinine, blood urea nitrogen, potassium, uric acid, or blood pressure, or other adverse event were observed during the study. In these groups of patients, gender was not an important factor to be considered when diltiazem is added to cyclosporine therapy.
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9.
[Diltiazem and verapamil therapy in patients with angina pectoris associated with arterial hypotension].
Idrisova, EM, Stepacheva, TA, Borovkova, NV, Chernov, VI, Karpov, RS, Vorob'eva, EV, Poponina, IuS
Klinicheskaia meditsina. 2004;(2):42-6
Abstract
A randomized blind cross-over study with placebo lead-in compared efficacy of calcium antagonists diltiazem and verapamil in 71 patients with stable angina concurrent with arterial hypotension (group 1) and 38 normotensive patients with ischemic heart disease (group 2). By acute bicycle exercise test evidence, verapamil was effective in 80% and 82% patients of group 1 and 2, respectively, dilitiazem--in 67 and 77%, respectively. Cumulation of the effect (p < 0.01) to the third month of verapamil course was comparable in both groups. Tolerance to an antianginal effect of dilitazem developed in 53% patients of group 1 (against 30% in group 2, p < 001) in 2-4 weeks of therapy (against 4-12 weeks in group 2, p < 0.05). By stress 199-T1 scintigraphy of the myocardium, administration of effective doses of diltiazem reduced the number of hypoperfused segments by at least 30%.
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10.
Does diltiazem inhibit the inflammatory response in cardiopulmonary bypass?
Fansa, I, Gol, M, Nisanoglu, V, Yavas, S, Iscan, Z, Tasdemir, O
Medical science monitor : international medical journal of experimental and clinical research. 2003;(4):PI30-6
Abstract
BACKGROUND The objective of our study was to investigate the anti-inflammatory effect and inhibiting action of diltiazem, a calcium channel blocking agent, on the systemic inflammatory response seen after cardiopulmonary bypass (CPB) in humans, in a controlled prospective study. MATERIAL/METHODS Two groups of 15 candidates for coronary artery bypass graft were enrolled in the study. In the study group, 1 g/kg/min of diltiazem was infused during cardiopulmonary bypass, while the control group received saline. Interleukin-6 and 10 (IL-6, IL-10) levels were measured from systemic arterial blood at five time points. RESULTS The levels of IL-6, a marker of the severity of systemic inflammation, were significantly higher in the control group at the end of CPB and 3 hours later. At the end of CPB, the mean IL-6 level in the control group was significantly higher than in the diltiazem group (p=0.015), and at 3 hours after CPB the difference was even greater (p=0.002). The levels of IL-10, an anti-inflammatory cytokine that limits the effects of pro-inflammatory cytokines, were higher in the control group, but not statistically significant at any time point. CONCLUSIONS Diltiazem inhibits the release of the pro-inflammatory cytokine IL-6, which is strong evidence for its anti-inflammatory effect. It is clinically important to inhibit the inflammation that takes place during CPB and the inflammation of myocardium encountered after ischemia-reperfusion, since these effect the clinical status of the patient after CPB, as well as myocardial functions.