Current Pharmaceutical Design - Volume 28, Issue 7, 2022

Heart failure (HF) and venous thromboembolism (VTE) are common clinical entities, closely interrelated, sharing multiple pathophysiological mechanisms. Their co-incidence is associated with further worsening of the prognosis of one another. Despite their frequent co-existence, important clinical questions still remain unanswered. The risk of VTE especially in chronic HF patients appears to vary widely in clinical studies, while the VTE-associated risk in HF patients is still not well determined and cannot be accurately predicted. Although scientific guidelines recommend venous thromboprophylaxis in patients hospitalized with an acute HF syndrome, venous thromboprophylaxis has not been studied adequately in prospective trials in ambulatory HF patients. In the present review, we aimed to summarize the current knowledge on the epidemiology of VTE and HF, the risk prediction for VTE occurrence in HF patients, the impact on patient outcome, and the need for anticoagulation in certain HF subgroups to improve prognosis, while we sought to identify gaps in knowledge that need to be addressed in the future.

Venous thromboembolism clinically presents as deep venous thrombosis or acute pulmonary embolism and is globally recognized as the third most frequent acute cardiovascular syndrome after myocardial infarction and stroke. Although pulmonary embolism does not typically cause severe pulmonary hypertension in the acute setting, thrombus organization and fibrosis can lead to stenosis or obliteration of pulmonary arteries in a minority of patients, which in turn result in severe pulmonary hypertension and right heart failure. This disease is labeled chronic thromboembolic pulmonary hypertension and can occur after a single episode or multiple ones of pulmonary embolism. The cornerstone of pulmonary embolism treatment is medical therapy, whereas systemic thrombolytic therapy has to be considered for patients with hemodynamic instability. Given the current acceptable short-term surgical mortality, the potential of first-line surgical embolectomy as an alternative to medical thrombolysis has gained momentum as far as pulmonary embolism treatment is concerned. In contrast to pulmonary embolism, bilateral complete pulmonary endarterectomy under short deep hypothermic circulatory arrest intervals is the treatment of choice against chronic thromboembolic pulmonary hypertension, given patients’ operability. Pulmonary endarterectomy is suggested in every operable patient when the operation is offered by an experienced multidisciplinary team, including at least one experienced surgeon. Surgical embolectomy should also be limited to large institutions since it also requires an experienced heart team. This review concerns a thorough discussion regarding surgical treatment of pulmonary embolism and chronic thromboembolic pulmonary hypertension. Eligibility criteria, operation-related complications and postoperative outcomes are discussed in detail.

Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. Patients with PE can present with a wide array of symptoms, ranging from mild to life threatening. The mainstay of PE treatment is anticoagulation; however, many advanced options are available for more severe patients, including catheter- directed interventions, surgical treatments, and hemodynamic support. Although different risk scores and clinical guidelines exist, the primary treating teams are frequently left uncertain on the most suitable treatment for a specific complex patient. Pulmonary Embolism Response Teams (PERT), composed of multidisciplinary experts, have emerged and been implemented in many centers and are available 24 hours a day to help guide the primary team. PERTs have changed the way complex PE patients are managed. In centers with a PERT, teams are called upon very frequently, and there is a significant increase in the use of advanced treatments for PE, although there are differences between centers based upon the center's specific PERT protocol and available capabilities. As PE is an evolving area, and more studies are necessary, PERTs around the world can help advance the field and improve the treatment offered to PE patients.

Background: Post-thrombotic syndrome (PTS) is the most common long-term complication of acute deep venous thrombosis (DVT). The cumulative incidence of PTS in the first two years after the first acute DVT diagnosis approximates 25%. Objective: This study aims to summarize the most recent updates and provide a comprehensive review of the current management of PTS. Methods: We searched MEDLINE/PMC/NCBI Bookshelf (PubMed), Cochrane, Embase, Scopus, ClinicalTrials, and OpenGrey databases for relevant articles in English published from the establishment of each separate database until February 9, 2021. Conclusion: PTS constitutes the most frequent long-term complication of lower limb deep venous thrombosis (DVT). Lifestyle changes and compression treatment represent an integral part of PTS management and have a clear benefit to offer in PTS patients. Pharmacological treatment with phlebotonic and non-phlebotonic medications, such as micronized purified flavonoid fraction (MMPF) and sulodexide, respectively, may have a more central and significant role in PTS management than previously thought. The introduction of percutaneous transluminal venoplasty (PTV) and stenting has again raised our expectations with the field, along with new concerns and considerations. There is a growing number of studies that report promising results on patientoriented outcomes on PTS patients who were treated with PTV and stenting. Moreover, hybrid (endovascular/ surgical) interventions may also represent a safe and efficacious treatment option for a subset of patients with PTS. Patient selection criteria for endovascular and hybrid interventional treatment should be carefully set and standardized. Post-operative care after venoplasty is an important field of future research with potential clinical impact. Management of deep and superficial reflux remains controversial. Hopefully, future prospective studies shall provide more robust evidence on the management of PTS.

Diabetic retinopathy is a posterior eye disorder in which damage occurs to the light sensitive retina due to diabetes mellitus. This disorder specifically affects people aged between 18-64 with type II diabetes. This disease progresses through different pathophysiological pathways, which include oxidative stress, inflammation, stimulation of the growth factor in the eye’s vasculature, isoforms of protein kinase C, and also the activation of the hexosamine pathway. It starts as micro aneurysms and advances in complicated stage, which results in retinal detachment. Treatment of posterior eye diseases has complications due to the structural design of the eye and physiological barriers present. The current treatment approach involves the use of intravitreal anti- VEGFs, corticosteroids implants, laser and surgery; these treatment methods have drawbacks attributed to them despite their benefits. The development of a robust delivery system with minimal or no invasion to tackle the issues of diabetic retinopathy will be of considerable benefit to patients having diabetic retinopathy; the dependency on ophthalmologists for multiple injections will significantly reduce and provide a promising approach in drug delivery. In this review article, the authors provided information related to existing treatment methods available for diabetic retinopathy, the most significant among which is nanotechnology approach through which local delivery via the ocular route to posterior eye can be achieved. It also possesses the various carriers studied for the non-invasive approach for retinal delivery of medicaments. Non-invasive approach for delivery of drugs can be considered as potential for the treatment of diabetic retinopathy.

Although there are many treatment options available for wound and burns dressings, improvements in technology are still required. Bacterial cellulose is a polymer derived from the microbiological world and has shown some promising properties that recommend it as a wound healing therapeutic. Moreover, bacterial cellulose can be nanosized to form Bacterial Nanocellulose (BNC), enhancing its properties. Most importantly, in addition to its inherent antibacterial properties, BNC can be used to deliver drugs. This article presents a birds-eye view of the preparation method and applications of BNC-based wound dressings.

Background: Muscle blind-like-proteins (MBNL) are a class of tissue-specific RNA metabolism regulators that control pre-messenger RNA-splicing. Inactivation of MBNL can lead to myotonic dystrophy in adults. MBNL is mainly expressed in skeletal muscle, neuron tissue, thymus, liver, and kidney and plays an important role in the ultimate differentiation of muscle cells and neurons. MBNL1 is a member of the MBNL protein family. The inactivation of MBNL1 protein is particularly important in the development of myotonic dystrophy and can lead to cataract formation, abnormal muscle relaxation, cardiac and neurological dysfunction, etc. The induction of MBNL1 in tumors is known to significantly inhibit tumor progression and thus significantly prolong survival. MBNL1 antisense protein MBNL1-AS1 also plays an important role in tumor migration and development. Objective: This review reveals the role of MBNL1 and MBNL1-AS1 in the complex pathogenesis of many tumors, which provide a new target for the treatment of tumors. Methods: Correlated research are systematically retrieved via PubMed. In this review, the role of MBNL1 and MBNL1- AS1 were analyzed. Results: MBNL1 is down-regulated in breast cancer, leukemia, stomach cancer, esophageal cancer, glioma, and Huntington's disease. The function of inhibiting tumor cell metastasis decreased. It is up-regulated in cervical cancer and colorectal cancer, which can promote the development of tumor cells. Antisense protein MBNL1- AS1 can inhibit tumor cell proliferation and metastasis in colorectal cancer, non-small cell lung cancer, and gastric cancer. Conclusion: MBNL1 is an important regulator of tumor metastasis and growth, which exhibits a promising therapeutic target and can be further explored.

Background: Sarcopenia is a progressive and generalized skeletal muscle disorder with unfavorable muscle changes throughout life, which can be associated with chronic disease. Testosterone supplementation is emerging as a possible therapy; however, it is still necessary to explore its effectiveness. Objectives: This systematic review and meta-analysis aimed to evaluate and summarize the evidence related to the effect of testosterone supplementation on sarcopenia components of chronic disease patients. Methods: We performed a systematic review and meta-analysis with studies that assessed the effect of testosterone supplementation on sarcopenia components of chronic disease patients. Papers were identified using Medical Subject Heading (MeSH) terms, combining “sarcopenia”, “muscular atrophy”, and “testosterone”, searching MEDLINE, EMBASE, and Cochrane Library databases, and also hand searching. Results: The database search resulted in 1602 applicable citations that could be included. Of those, 1560 were removed at the first phase, by reading the title and abstract, and a total of 17 studies were finally included after full-text assessment and manual searches of previous review references. With regard to the effects of testosterone supplementation on sarcopenia components, when taken together, the evaluated studies presented an increase in muscle mass and/or muscle strength, but results for muscle functional capacity were inconsistent. Conclusion: Testosterone supplementation increased the muscle mass and muscle strength in chronic disease patients. However, current evidence does not indicate that those patients could benefit from testosterone supplementation in order to improve their muscle function.