Aortic Root Dilatation in Children and Adolescents At Al-Hawary General Hospital, & National Benghazi Cardiac Center -Libya

Isolated dilatation of the aortic root and/or ascending aorta is a rare but well-known cardiovascular manifestation, can be caused by a variety of congenital or acquired conditions; that lead to the weakening of the aortic wall. The study aimed to detect the cause and the rate of the aortic root dilatation in children and adolescents, and to assess the effect of the Beta-adrenergic blockers in preventing further dilatation in the aortic root. A case series study was perform with five years of follow-up at Al-Hawary General Hospital, National Benghazi Cardiac Center. A total of 91 patients were seen with ascending aortic dilatation and/or root dilatation during the period from 6/2016 - 6/2021 included in the study diagnosed by clinical examination, chest x-ray, and echocardiogram. The diagnosis in 34/91(37%) was Tetralogy of fallout (TOF) and truncus arteriosus, 57/91 (63%) was dilated aortic root, 25/57 (44%) bicuspid aortic valve (BAV), 22/57 (38.5%) Marfan syndrome, 4/57(7%) Noonan syndrome, 2/57(3.5%) Turner syndrome, 3/57(5%) Ehlers-Danlos syndrome, 1/57(2%) idiopathic. Follow-up results of three months – five years: 57/91 patients with aortic root dilatation were followed up, none of the Marfan syndrome and Ehlers-Danlos syndrome patients who received beta-blockers had shown progression in the dilatation of the aortic root, and all patients who had bicuspid aortic valve did not show any progression in the dilatation without using medication. Conclusions: Dilated aortic root is a common finding in Marfan syndrome, bicuspid aortic root, and Ehlers-Danlos syndrome, and its progress could be decreased by using beta-adrenergic blockers in rapidly progressing dilation.

A primer on hypertension and on the racial / ethnic disparities in diagnosis and management: a comprehensive overview

Hypertension is a major cause of premature death worldwide, where it contributes to stroke, cardiovascular and renal disease. Forty percent of adults aged 30-79 years worldwide have hypertension, two-thirds of whom are living in low and middle-income countries. Most adults with hypertension are not fully aware that they have the condition, therefore it often goes ignored and untreated. Of the 1.28 billion people worldwide, who have been reported to have hypertension, data indicates that one in five females and one in four males are included in that estimate. Moreover, data from World Health Organization reports that less than half of adults (42%) with hypertension are diagnosed and treated adequately and approximately only one in five adults (21%) with hypertension have it under adequate control. One of the worldwide goals for non-communicable diseases is to scale back the prevalence of hypertension by 33% between 2010 and 2030. In African Americans, readily available thiazide diuretics or Calcium Channel Blockers (CCBs) have been shown to be more effective in lowering blood pressure than Renin Angiotensin System inhibitors (RAS) or β-adrenergic blockers and are also more effective in reducing cardiovascular disease (CVD) events than RAS inhibitors or adrenergic blockers. The ethnical difference in hypertension and hypertension- related complaint issues are associated with lesser mortality and morbidity pitfalls compared with their white counterparts. These redundant pitfalls from elevated blood pressure have a dramatic effect on life expectancy and career productivity for African American men and women and which is significantly lower than has been reported for Caucasian Americans of either gender. These present challenges remain to be completely understood and give a result to overcome ethnical and racial differences in the frequency and treatment of hypertension. Social determinants of health similar as educational status, access to health care and low income play a crucial part in frequency and blood pressure control rates. Development of appropriate health care programs at the state and public situations to address these issues will be essential to reduce these differences. Thus, the purpose of this paper is to review the prevalence and ethnic disparities in the diagnosis and treatment of hypertension and to suggest steps to improve the outcomes.

Interactions Networks for Primary Heart Sarcomas

Personalized medicine incorporates genetic information into medical practice so as to optimize the management of chronic diseases. In rare diseases, such as heart cancer (incidence 0.0017–0.33%), this may be elusive. Ninety-five percent of the cases are due to secondary involvementwith the neoplasm originating in the lungs, breasts, kidney, blood, or skin. The clinical manifestations of heart tumors (benign or malignant) include heart failure, hypertension, and cardiac arrhythmias of varying severity, frequently resulting in blood vessel emboli, including strokes. This study aims to explain the pathophysiology and contribute to a P4 medicine model for use by cardiologists, pathologists, and oncologists. We created six gene/protein heart-related and tumor-related targets high-confidence interactomes, which unfold the main pathways that may lead to cardiac diseases (heart failure, hypertension, coronary artery disease, arrhythmias), i.e., the sympathetic nervous system, the renin-angiotensin-aldosterone axis and the endothelin pathway, and excludes others, such as the K oxidase or cytochrome P450 pathways. We concluded that heart cancer patients could be affected by beta-adrenergic blockers, ACE inhibitors, QT-prolonging antiarrhythmic drugs, antibiotics, and antipsychotics. Interactomes may elucidate unknown pathways, adding to patient/survivor wellness during/after chemo- and/or radio-therapy.

Young woman diagnosed with paraganglioma in primary care

A 15-year-old young woman was referred to the emergency room for admission by her general practitioner after receiving the results of urinary metanephrines and catecholamines requested to study the tachycardia, sweating and headaches that she had been presenting progressively last year. Imaging tests showed a large right supraumbilical para-aortic paraganglioma that was successfully removed with surgery after previous medical preparation with adrenergic blockers. Genetic testing showed a heterozygous mutation of the gene succinate dehydrogenase-B. The classic triad of symptoms in these disorders consists of headaches, sweating and tachycardia, usually accompanied by hypertension. We wanted to present this case, a challenging diagnosis of paraganglioma in primary care.

Daptomycin: A Novel Macrocyclic Antibiotic as a Chiral Selector in an Organic Polymer Monolithic Capillary for the Enantioselective Analysis of a Set of Pharmaceuticals

Daptomycin, a macrocyclic antibiotic, is here used as a new chiral selector in preparation of chiral stationary phase (CSP) in a recently prepared polymer monolithic capillary. The latter is prepared using the copolymerization of the monomers glycidyl methacrylate (GMA) and ethylene glycol dimethacrylate (EGDMA) in the presence of daptomycin in water. Under reversed phase conditions (RP), the prepared capillaries were tested for the enantioselective nanoliquid chromatographic separation of fifty of the racemic drugs of different pharmacological groups, such as adrenergic blockers, H1-blockers, NSAIDs, antifungal drugs, and others. Baseline separation was attained for many drugs under RP-HPLC. Daptomycin expands the horizon of chiral selectors in HPLC.

Stress and arterial hypertension - from pathophysiology to pharmacology

Arterial hypertension is the most massive chronic non-infectious disease of mankind nowadays. It may remain undiagnosed for years, provoking later complications, such as acute heart failure, cerebrovascular stroke, myocardial infarction, renal failure, hypertensive retinopathy, or sudden death. Primary arterial hypertension is more common, while secondary occurs in about 5-20% of cases. The recent studies have shown that stress may be a core factor in development of essential hypertension in some patients. For the patients suffering from post-traumatic stress disorder, stress is the dominant etiological factor that leads to the disease. It has been proven that chronic stress can affect blood pressure regulation and endocrine-metabolic functions through the limbic-hypothalamic centers, therefore it can affect the arterial hypertension development. The strong association between stress and arterial hypertension have been also confirmed in preclinical and animal studies. For the pharmacotherapy approach, the most important are beta-adrenergic blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors) and AT1-receptor blockers (sartans). As a second line treatment, calcium channel blockers, diuretics, alpha-adrenergic blockers, and central antihypertensive agents may be required. The anxiolytics, such as benzodiazepines, should be considered if chronic anxiety and psychosomatic disorders are present.

Clinical pharmacology of pyrroxane (proroxane)

Review of literature and own studies on the pharmacology and clinical pharmacology of the domestic -adrenergic blocker pyrroxan (INN: proroxane). The drug was developed in the 1970s at the Institute of Toxicology of the USSR Ministry of Health (Leningrad). Expectations from -blockers created during this period (phenoxybenzamine, phentolamine, tropafen, fepracet, dihydrogenated ergot alkaloids) were high, especially in terms of the treatment of hypertensive and ischemic conditions, however, only few drugs from this group were used in clinical practice for these purposes (prazosin, doxazosin and some others). For pyrroxan, this direction was not the main one, and it was positioned as a means of treating diencephalic disorders like vegetative crises, where the drug immediately gained popularity, and this direction of use was clearly fixed to it. In the same period, the anti-alcohol and anti-drug action of -adrenergic blockers was found, since both in the experiment and in the clinic they demonstrated the suppression of alcohol (drug) motivation and a decrease in alcohol and drug consumption. Thelatter served as an impetus to the use of pyrroxane mainly in psychiatry, narcology and, to a lesser extent, in neurology, and recently the drug has been positioned almost exclusively for use in these areas of medicine. Thearticle analyzes the current clinical use of pyrroxane.

Clinical pharmacology of pyrroxane (proroxane)

Review of literature and own studies on the pharmacology and clinical pharmacology of the domestic -adrenergic blocker pyrroxan (INN: proroxane). The drug was developed in the 1970s at the Institute of Toxicology of the USSR Ministry of Health (Leningrad). Expectations from -blockers created during this period (phenoxybenzamine, phentolamine, tropafen, fepracet, dihydrogenated ergot alkaloids) were high, especially in terms of the treatment of hypertensive and ischemic conditions, however, only few drugs from this group were used in clinical practice for these purposes (prazosin, doxazosin and some others). For pyrroxan, this direction was not the main one, and it was positioned as a means of treating diencephalic disorders like vegetative crises, where the drug immediately gained popularity, and this direction of use was clearly fixed to it. In the same period, the anti-alcohol and anti-drug action of -adrenergic blockers was found, since both in the experiment and in the clinic they demonstrated the suppression of alcohol (drug) motivation and a decrease in alcohol and drug consumption. Thelatter served as an impetus to the use of pyrroxane mainly in psychiatry, narcology and, to a lesser extent, in neurology, and recently the drug has been positioned almost exclusively for use in these areas of medicine. Thearticle analyzes the current clinical use of pyrroxane.