Cardiovascular & Hematological Agents in Medicinal Chemistry (Formerly Current Medicinal Chemistry - Cardiovascular & Hematological Agents) - Volume 17, Issue 2, 2019

This review is directed at increasing awareness of two diverse rare upper gastrointestinal problems that occur at opposite ends of the age spectrum and are difficult to diagnose and treat. The Superior Mesenteric Artery Syndrome (SMAS) likely involves a young patient, especially female, and is especially associated with rapid weight loss, resulting in relative strangulation of the duodenum by a narrowing of the angle between the Superior Mesenteric Artery (SMA) and the aorta. On the other hand, atherosclerosis of the SMA is associated most likely with postprandial upper intestinal ischemia and abdominal pain occurs in the elderly at high risk for cardiovascular (CV) disease. Medical management of the SMAS in the young involves good alimentation and weight gain to overall increase the intestinal fat pad. Medical management of SMA atherosclerotic ischemia in the elderly is directed at marked lipid lowering with atherosclerotic plaque stabilization or even regression. If needed, surgery for SMAS can be attempted laparoscopically with duodenojejunoscopy which is the most popular procedure but there are also more conservative possibilities that avoid division of the duodenum. In addition, sometimes direct vision is needed to successfully operate on SMAS. If surgery is needed for SMA atherosclerotic ischemia, it is usually attempted endoscopically with angioplasty and stent placement. Most important, in the case of these two rare clinical entities, is that the clinician have a suspicion of their presence when indicated so that the young or old patient can be spared unnecessary suffering and return to good health in a timely fashion.

Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second most prevalent form of alternate tobacco products. The rapid increase in hookah use is because of the misconception prevalent in society that hookah smoking is less harmful than cigarette smoking. Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal models and human cells has shown consistently mutagenic, oxidative, and inflammatory changes that could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis and chronic obstructive pulmonary disease. Studies on the chemistry of waterpipe smoke had shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants, and 31 respiratory irritants. Enormous data exist showing waterpipe smoking causing various health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence of coronary heart disease, heart failure, ST-segment elevation myocardial ischemia, recurrent ischemia, and worse outcomes including mortality related to these diseases. The objectives of the review are to assess the factor associated with the increasing use of hookah, its health effects, options for hookah smoking cessation, and public health policy initiatives to mitigate waterpipe use.

Background: Heart Failure (HF) is accompanied by a high cost of care and gloomy prognosis despite recent advances in its management. Therefore, efforts to minimize HF rehospitalizations is a major focus of several studies. Methods: We conducted a retrospective cohort study of 140 patients 18 years and above who had baseline clinical parameters, echocardiography, NT-ProBNP, troponin I and other laboratory parameters following a 3-year electronic medical record review. Patients with coronary artery disease, preserved ejection fraction, pulmonary embolism, cancer, and end-stage renal disease were excluded. Results: Of the 140 patients admitted with HF with reduced Ejection Fraction (HFrEF) secondary to non-ischemic cardiomyopathy, 15 were re-hospitalized within 30 days of discharge while 42 were rehospitalized within 6 months after discharge for decompensated HF. Receiver operating characteristic (ROC) cutoff points were obtained for NT-ProBNP at 5178 pg/ml and serum troponin I at 0.045 ng/ml. After Cox regression analysis, patients with HFrEF who had higher hemoglobin levels had reduced odds of re-hospitalization (p = 0.007) within 30 days after discharge. NT-ProBNP and troponin I were independent predictors of re-hospitalization at 6 months after discharge (p = 0.047 and p = 0.02), respectively, after Cox regression analysis. Conclusion: Troponin I and NT-ProBNP at admission are the best predictors of re-hospitalization 6 months after discharge among patients with HFrEF. Hemoglobin is the only predictor of 30 -day rehospitalization among HFrEF patients in this study. High-risk patients may require aggressive therapy to improve outcomes.

Background: Chronic heart failure is a complex clinical syndrome with typical symptoms that can occur at rest or on effort. It requires patients to manage their lifestyle with their disease and when to notify their healthcare provider. The study was aimed to identify medication adherence and associated factors among chronic heart failure clients on follow up Oromia region, West Ethiopia, 2017. Methods: Institutional based cross-sectional study design was employed, after selecting three hospitals by lottery method and allocating respondents to the three hospitals proportionally. A total of 424 patients were admitted to the medical ward and/or chronic follow up of Nekemte referral, Gimbi, and Shambu hospitals. The data was collected using a structured questionnaire. The data was entered into Epi-data version 3.1, cleared, explored, and then exported to SPSS windows version 24.0 for further analysis. Variable having a p-value less than 0.05 in the bivariate analysis was a candidate for multivariable analysis and the effect of confounding variables was observed. Variables having a p-value less than 0.05 in the multivariable analysis were assumed significant. Results: A total of 424 respondents were included in the final analysis giving a 95.3% response rate. The result indicated that more than half of the study participants have adhered to prescribed medication. Respondents with good medication adherence were more likely to adhere to good self-care behavior [AOR (95% CI of OR) = 3.5(2.044, 5.96)]. Respondents whose limited fluid intake was one or half-liter per day were more likely to adhere to the medication [AOR (95% CI of OR) = 2.5(1.43, 4.49)]. It was also found that those patients who avoided spices, sauces and others in food are more likely to adhere to the medication [AOR (95% CI of OR) = 2.2 (1.152, 4.039)]. Conclusion and Recommendation: Even if more than half of the study respondents have good medication and self-care adherence, still it needs great attention in health education over their visit. Health institutions are strongly recommended to give health education for clients and researchers to use advanced study design for measuring medication adherence and self-care behaviors.

Aim: This study aims to find out the components responsible for the antithrombotic activity of Nelumbo nucifera. Material and Methods: Petroleum ether, chloroform and hydroalcoholic extracts of whole plant of Nelumbo nucifera (Lotus) were prepared and assessed for its thrombolytic, anti-platelet aggregation activity and bleeding time. The extracts were further analyzed through HPTLC and GC-MS. Statistical analysis was conducted through ANOVA trailed by Tukey’s multiple comparison test test. Results: Hydroalcoholic extract showed the highest activity at the concentration of 400μg/ml in thrombolytic assay (42.03 ± 5.76), anti-platelet aggregation assay (57.93 ± 1.68) and bleeding time (70.17 ± 2.16) in comparison to clopodigrel (33.76 ± 3.43), aspirin (66.55 ± 1.86) and aspirin (93.85 ± 2.75) at the concentration of 100 μg/ml respectively. 25 peaks were identified through GC-MS, out of which, ferulic acid (14.2μ/g) and quercetin (5.4 μ/g) are active chemical compounds. HPTLC showed different chromatograms in hydroalcoholic extracts like (1) chlorogenic, (2) quercetin, (3) benzoic acid, (4) caffeic acid, (5) ferulic acid, (6) kaempferol, and (7) gallic acid. Conclusion: Based on these findings, flavonoids present in hydroalcoholic extract may be developed into a drug for clinical application for the treatment of thrombosis in patients.

Background: Mobile health technology offers promising means to implement public health strategies for the prevention and management of chronic conditions. However, at the moment, there is a dearth of both; specific mobile health tools tailored for the knowledge and language needs of Indian population; as well as enough systematic and scientific clinical data to analyse their impact in varied Indian socioeconomic and disease populations. Objective: To develop a smartphone-based bilingual educational mobile application for heart patients and pilot test in an Indian clinical setting. Methods: An Android™ based mobile application was developed according to a systematic instructional design model. Thereafter, expert assessment was done by 3 software engineers and 2 healthcare professionals using a peer-reviewed, objective and multidimensional Mobile Application Rating Scale (MARS). A pilot user satisfaction evaluation was done based on feedback from 35 Coronary Artery Disease patients visiting Cardiology outpatient Department of a North Indian tertiary care centre. Results: An Android™ based mobile application named as ‘Happy Heart’ was developed. The content was developed in both Hindi and English under professional supervision. For this mobile application, the Mean MARS score was 3.60 ± 0.86 and subjectivity score was 3.30 ± 1.03. The overall user satisfaction response for the mobile application was 4.09 ± 0.75 indicating that most of the testers found it useful. Conclusion: This mobile application is developed as a research tool to further conduct a clinical study in Coronary Artery Disease Patients. Current evaluation was a pilot testing wherein this application showed promising results.

Background: Matricaria pubescens is a medicinal plant from North Africa. This plant is widely used in alternative medicine as a remedy against rheumatism, inflammation, diabetes and hypertension. Aim: The aim of the study was to evaluate the possible antihypertensive and vasodilator activity of the aqueous extract of Matricaria pubescens (M. pubescens). Material and Methods: In the current study, the aqueous extract of the aerial parts of M. pubescens (AEMP) was prepared and its antihypertensive activity was examined in N(ω)-nitro-L-arginine methyl ester (L-NAME)-induced hypertensive rats. Results: The results indicated that AEMP reduced the systolic, diastolic, mean arterial blood pressure in hypertensive rats but not in normotensive rats. The data revealed that AEMP exhibits its antihypertensive effect through vasorelaxant activity. More interestingly, this study approved that the vasorelaxant capacity of AEMP seems to be mediated through vascular cyclooxygenase pathway, the opening of K+ channels and sGC-cGMP induction pathway. Conclusion: The study illustrates the beneficial action of M. pubescens as an antihypertensive agent.

Introduction: Recent findings have shown that in Acute Ischemic Stroke (AIS) patients, elevated troponin is associated with increased mortality. However, due to concerns of cerebral hypoperfusion and hemorrhagic transformation, current practice has been slow to apply proven cardiac therapies to these patients. This study aims to determine this rate of utilization. Materials and Methods: A single-center review of 83 patients with AIS and measured troponin was conducted. Patients were stratified based on elevated and non-elevated troponin. Between groups, we measured the utilization of evidence-based cardiac therapies and used a univariate logistic regression to compare outcomes of mortality, re-hospitalization, recurrent acute ischemic stroke, recurrent acute myocardial infarction, and a composite of these outcomes. Results: Of 83 patients, 25 had elevated troponin and 58 had non-elevated troponin. There was no statistical difference in the use of cardiac therapies between the two groups. Adenosine diphosphate P2Y12 antagonists were infrequently used in both elevated and non-elevated troponin groups at 32% vs. 24% (p = 0.64), as were Angiotensin-Converting Enzyme Inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) at 56% vs. 69% (p = 0.38). Those in the elevated troponin group encountered a statistically significant increase in composite endpoint 64% vs. 33% (Odds Ratio [OR] 7.28, 95% Confidence interval [CI] 2.19-28.88, p<0.01). Conclusion: Cardiac therapies are underutilized in patients with acute ischemic stroke and elevated troponin levels. In turn, this low usage may explain the increase in morbidity and mortality seen in these patients and the use of such therapies should be considered when treating this subset of patients as the cardio protective nature of these therapies may outweigh the risks associated with them in AIS patients.