Cardiovascular & Haematological Disorders - Drug Targets - Volume 21, Issue 2, 2021

After the outbreak of COVID-19, many novel drugs have been introduced to improve patients’ conditions. Remdesivir and Favipiravir are among the most common drugs used against SARS-CoV-2. Although promising, cardiovascular side effects of these drugs should be considered by physicians and nurses. In this study, we searched databases for assessing the cardiovascular side effects of Remdesivir and Favipiravir. It seems that despite the beneficial effects of these drugs, due to the cardiovascular complications of COVID-19 and cardiovascular side effects of these drugs, which can overlap with each other, the use of these drugs can be a challenging issue in the cardiovascular practice.

Background: Lipid accumulation in the liver, skeletal and cardiac muscle, kidneys and pancreas causes cell dysfunction, death and inflammation, a biological phenomenon named lipotoxicity. Erythrocytes participate in the transport of lipids in the circulation, and their lipidome is determined by exchange with blood components. Objective: The objective of this study is to summarize the current knowledge regarding the effect of toxic lipid accumulation in erythrocytes. Results: Erythrocyte lipidome is altered in lipotoxic diseases, such as fatty liver disease, heart failure and diabetes. In addition, ceramide, lysophosphatidylcholine, lysophosphatidic acid, palmitic acid and free cholesterol induce erythrocyte malfunction. Conclusion: Erythrocytes are an additional cell target of lipotoxicity. Further exploration of the implicated molecular mechanisms could lead to novel therapeutic targets for cardiometabolic and hematological diseases.

Medicinal preparations currently used for the treatment of patients with chronic cardiac failure involve those that reduce the heart load (vasodilators, diuretics, beta-blockers, and angiotensin- converting enzyme (ACE) inhibitors). Cardiotonic drugs with the cAMP-dependent mechanism are unsuitable for long-term administration due to the intensification of metabolic processes and an increase in the oxygen demand of the myocardium and all tissues of the body. For many years, digoxin has remained the only preparation enhancing the efficiency of myocardial performance. The detection of digoxin and ouabain in intact animals has initiated a search for other compounds with cardiotonic activity. The review summarizes current data on the effect exerted on the heart performance by endogenous compounds, from simple, such as NO and CO, to steroids, fatty acids, polypeptides, and proteins. Controversial questions and problems with the introduction of scientific achievements into clinical practice are discussed. The results obtained by the authors and their colleagues after many years of studies on the cardiotropic properties of serum lipoproteins are also reported. The experimentally established cardiotonic activity of apoprotein A-1, which is accompanied by a decrease in the relative consumption of oxygen, maybe of great interest.

Background: Herbal drugs and their derived phytochemicals are valuable for human beings as a source of a vital component of food material and drugs. Flavonoids are naturally occurring phytochemicals produced in plants through metabolisms, and they have anti-hyperlipidemia, anti-inflammatory, anti-oxidant and anti-apoptotic activity. Flavonoids have been identified in fruits, nuts, vegetables, seeds, stems, flowers, and tea. Kaempferol is a natural flavonoidal compound present in edible plants such as apples, broccoli, strawberries, beans, grapefruit, propolis, and medicinal plants such as Aloe vera, Ginkgo biloba, Rosmarinus officinalis, Crocus sativus L., Hypericum perforatum L. Kaempferol have anti-oxidant, anti-inflammatory, anti-apoptotic, proapoptotic, cardio-protective and anti-cancer activities. Methods: Glycosides of kaempferol such as kaempferitrin, also called kaempferol 3,7-dirhamnoside are known to be more abundant than their flavonoid monomers in plants. Various literature databases have been searched to collect all the scientific information of kaempferitrin in the present investigation and analyzed in order to know the therapeutic benefit and biological potential of kaempferitrin. Moreover, all the information has been presented here in two broad sections, i.e., pharmacological and analytical. Results: From the analysis of all the collected and presented information, it was found that kaempferitrin has potent insulin-mimetic potential and could be used for the treatment of diabetes and related complications. However, it has also shown anti-oxidant, anti-inflammatory, anti-convulsant, anti-osteoporotic, anti-depressant, anthelmintic, immunostimulatory, and natriuretic properties and inhibits cell proliferation and apoptosis. Kaempferitrin also improves the meat quality of broiler chickens. Conclusion: The presented information in this work will be valuable to justify the biological importance and therapeutic potential of kaempferitrin in the scientific field.

Background: The protein coded by the cystathionine β synthase (CBS) gene acts as a catalyzer and converts homocysteine to cystathionine. Impairment of the CBS gene leads to homocystinuria by cystathionine β synthase deficiency which is linked to Coronary Artery Disease. A number of polymorphisms studies have been performed on the cystathionine β synthase gene. In the current study, we planned to analyze the influence of CBS T833C gene polymorphism(exon 8 cystathionine rs5742905T T>C), its association with Coronary Artery Disease development, and its progression in the north Indian population. Materials and Methods: The present study comprises 100 angiographically confirmed CAD patients and 100 age and sex-matched healthy controls. A total of 50% or more luminal stenosis at one major coronary artery was considered for the inclusion criteria of the cases. The investigation of T833C polymorphism in the CBS gene was performed by PCR- RFLP technique. Results: As a result, we found that homozygous mutant (CC) and heterozygous (TC) genotypes of CBS T833C gene polymorphism were significantly higher in CAD patients than in healthy subjects. We also observed a substantially increased CAD risk in dominant, codominant inheritance, and allele-specific models for the CBS T833C gene polymorphism. We analyzed the differential distribution with respect to disease severity, but there was no significant association (p=0.96). Conclusion: In conclusion, this study demonstrates that CBS T833C gene polymorphism plays a key role in developing coronary artery disease and its progression.

Background: There is inadequate information on the risk of gastrointestinal (GI) bleeding in patients who are under rivaroxaban and warfarin therapy in Iran. Determining the risk of GI bleeding in patients receiving these two drugs can help to select a more appropriate anti-coagulation prophylaxis in high-risk patients. Objective: The aim of this study was to compare the incidence of GI bleeding in patients with atrial fibrillation (AF) and concomitant bleeding risk factors receiving either warfarin or rivaroxaban. Methods: In this observational study, 200 patients with AF and bleeding risk factors who referred to Imam Hossein Hospital (Tehran, Iran) were included. The patients were under treatment with either warfarin or rivaroxaban. The incidence of GI bleeding was compared between the two groups monthly for one year. Results: GI bleedings were observed in 61% and 34% of patients treated with warfarin and rivaroxaban, respectively (P = 0.001).Melena was the most common type of GI bleeding in both groups. History of hypertension, history of stroke, consumption of anti-platelet drugs, NSAID consumption, and history of alcohol consumption were associated with more frequent GI bleeding only in warfarin group. Conclusion: The incidence of GI bleeding was lower in AF patients who received rivaroxaban compared to those treated with warfarin. Also, GI bleeding risk does not change according to the consumption of other anti-coagulant drugs and underlying history of hypertension or stroke in patients received rivaroxaban. Therefore, rivaroxaban is suggested as the choice of prophylaxisin patients with AF and concomitant coagulopathy.

Objective: To assess the safety and efficacy of Novel tapered (BioMime™ Morph) sirolimus- eluting stent (SES) for left main PCI in a real-world scenario. Background: Currently, no data is available on clinical usefulness of tapered ultrathin stents in left main PCI. Methods: This was a prospective, non-randomised, single centre study carried out between February 2018 and May 2020 at a tertiary cardiac care centre in southern India. The study included patients treated with BioMime Morph tapered stent for distal de novo LMB lesion or ostial LAD/LCX lesions with significant size disparity between reference segments based on the eligibility criteria. Primary endpoint of the study was the cumulative incidence of major adverse cardiovascular events (MACE) composed of cardiac death, myocardial infarction, and clinically driven target-lesion revascularisation at follow-up. Results: A total of 41 patients (average age of 54.83±9.81 years) were included in the study. Average SS-2 score was 23.17±5.42. Majority of the lesions (n=31; 75.61%) were of medina class (0.1.0). Provisional single stent strategy was adopted for treatment of LMB lesions. TIMI flow-3 was achieved in 40 patients (97.56%). Median clinical follow-up was 20 months (range 6-34 months). There was no periprocedural complication or MACE during follow-up. Conclusion: Tapered stents may be an acceptable alternative for LM intervention in an anatomical subset of patients with tapered vessels.

Background: Hypertension is a global public health concern. Awareness and knowledge about the disease in a community collectively would allow adequate prevention, promote self-care practices, adherence to medication and ultimately effective management of hypertension. Aims: To ascertain the level of education associated with the knowledge of hypertension and control of blood pressure. Methods: A cross-sectional questionnaire survey consisting of item questions about awareness and knowledge of hypertension. Hypertensive patients (n = 424) of both genders and more than 20 years of age were included in the study. Hypertensive patients were divided into two groups (school group and school pass-out group) to assess the level of knowledge. Chi-square test was performed to determine the assessment, and p-value < 0.05 was considered significant. Results: Out of 424 participants, 71.2% were school group and 28.7% school pass-out group. School pass-out group had significant knowledge about dangerous natural course of hypertension (p = 0.00069), hypertension can lead to death if untreated (p = 0.015), benefits of cessation of smoking (p = 0.03), advantage of limiting alcohol (p = 0.019) and performing regular exercise (p = 0.013) reduces blood pressure. School pass-out group had significant (p = 0.04) hypertension control compared to the school group. Conclusion: Educational status plays a vital role in increasing knowledge and improving the management of hypertension through better self-care practices and strict adherence to medication. Community- based health education interventional programs targeting the lower socioeconomic group of a population would help to reduce the gap in awareness and effective control of hypertension.

Background: Heart diseases are the leading causes of mortality and Congenital Heart Disease (CHD) is the most common birth defect reported worldwide. Objective: The aim of this study was to evaluate the incidence of arrhythmias and CHD and the association between the two, among infants and children reported to our center. Methods: This cross-sectional study included infants and children who were referred to Shahid Madani Hospital, Khorramabad. Electrocardiogram (ECG) was performed in these children to determine the type of arrhythmia and records were used to obtain demographic data and the data regarding CHD. Results: Of 200 children enrolled in the study, 10 children had arrhythmias, 12 had tachycardia, 5 had bradycardia, and 31 had congenital disease. Among children with arrhythmias, 1 had atrial fibrillation, 4 patients had paroxysmal supraventricular tachycardia, 1 person had right bundle branch block, 1 had ventricular tachycardia, 2 had premature ventricular contractions and 1 had junctional ectopic tachycardia. Of the 31 children with CHD, 9 patients were presented with small ventricular septal defect, 4 children had patent foramen ovale, 2 had pulmonary stenosis and 1 of the children had tetralogy of fallout, arterial and ventricular septal defects and transposition of greater arteries, respectively. Conclusion: We reported a positive correlation between the arrhythmias and CHD. A larger number of studies collecting focusing on different age groups are therefore required to verify our findings.

Chronic myeloid leukemia (CML) is predominantly a disease of adults and the elderly. CML is uncommon in the paediatric age. Priapism as an initial presentation is quite uncommon in CML and is rare in the case of CML in paediatric and adolescent age. We present a case of CML in an adolescent male who presented with priapism of 48 hours duration. The patient was managed in an emergency by corporal aspiration and saline irrigation and was found to have CML during a hospital stay. The patient was treated with imatinib and is under follow-up for the last two years.