Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis

Background: The medical treatments of chronic heart failure have made remarkable progress in recent years. It is crucial to determine the optimal drug combination based on current evidence.Methods: A search of PubMed, EMBASE, and Cochrane CENTRAL databases was conducted for studies on angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 inhibitors (SGLT2is), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and ivabradine (IVA) between 1987 and 2021. The network meta-analysis was performed to compare the efficacy of drug therapies in heart failure with reduced ejection fraction (HFrEF).Results: Forty-eight randomized controlled trials (RCTs), which overall included 68,074 patients with HF and left ventricular ejection fraction (LVEF) ≤ 40%, were identified and included in the network meta-analysis. The efficacies of 13 intervention classes, including monotherapies or combinations of ACEI, ARB, ARNI, BB, MRA, SGLT2i, IVA, and placebo, on hospitalization for HF, cardiovascular mortality, and all-cause mortality were compared. Among the 13 included interventions, ARNI+BB+MRA, SGLT2i+ACEI+BB+MRA, and IVA+ACEI+BB+MRA were found to be best in terms of all three outcomes. Compared with placebo, these three drug combinations were associated with significant reductions in the risk of all-cause death, cardiovascular mortality and hospitalization for HF.Conclusions: ARNI+BB+MRA, SGLT2i+ACEI+BB+MRA, and IVA+ACEI+BB+MRA were the top three therapies for patients with HFrEF. The increasing use of combinations of conventional and novel drugs contributed to progressive reductions in hospitalization and mortality in patients with HFrEF.

Oral Hygiene Practice among Hospitalized Patients: An Assessment by Dental Hygiene Students

Aim: An epidemiological study was carried out, in hospital wards, with the aim of assessing the oral health status of patients subjected to multiple medical treatments. Material and Methods: The study was conducted at Fondazione IRCCS Policlinico San Matteo (Pavia, Italy). A questionnaire was submitted to patients for the evaluation of oral hygiene devices used; then, a clinical examination was conducted to collect Decayed Missing Filled Teeth (DMFT) index, Plaque Index (PI), and Marginal Gingival Index (MGI) values. Results: Manual toothbrushes were used by a wide range of the sample study (65–100% among hospital wards), together with mouthwash (20–80%); interproximal aids were used by few patients (the lowest recorded value was 33.3%). Conclusion: dental hygienists could be integrated into hospital wards as oral hygiene procedure instructors, for the improvement of the oral health conditions of hospitalized patients.

Development and Characterization of Curcumin-Silver Nanoparticles as a Promising Formulation to Test on Human Pterygium-Derived Keratinocytes

Pterygium is a progressive disease of the human eye arising from sub-conjunctival tissue and extending onto the cornea. Due to its invasive growth, pterygium can reach the pupil compromising visual function. Currently available medical treatments have limited success in suppressing efficiently the disease. Previous studies have demonstrated that curcumin, polyphenol isolated from the rhizome of Curcuma longa, induces apoptosis of human pterygium fibroblasts in a dose- and time-dependent manner showing promising activity in the treatment of this ophthalmic disease. However, this molecule is not very soluble in water in either neutral or acidic pH and is only slightly more soluble in alkaline conditions, while its dissolving in organic solvents drastically reduces its potential use for biomedical applications. A nanoformulation of curcumin stabilized silver nanoparticles (Cur-AgNPs) seems an effective strategy to increase the bioavailability of curcumin without inducing toxic effects. In fact, silver nitrates have been used safely for the treatment of many ophthalmic conditions and diseases for a long time and the concentration of AgNPs in this formulation is quite low. The synthesis of this new compound was achieved through a modified Bettini’s method adapted to improve the quality of the product intended for human use. Indeed, the pH of the reaction was changed to 9, the temperature of the reaction was increased from 90 °C to 100 °C and after the synthesis the Cur-AgNPs were dispersed in Borax buffer using a dialysis step to improve the biocompatibility of the formulation. This new compound will be able to deliver both components (curcumin and silver) at the same time to the affected tissue, representing an alternative and a more sophisticated strategy for the treatment of human pterygium. Further in vitro and in vivo assays will be required to validate this formulation.

Auranofin and its analogs as prospective agents for the treatment of colorectal cancer

Today colorectal cancer (CRC) is one of the leading causes of cancer death worldwide. This disease is poorly chemo-sensitive toward the existing medical treatments so that new and more effective therapeutic agents are urgently needed and intensely sought. Platinum drugs, oxaliplatin in particular, were reported to produce some significant benefit in CRC treatment, triggering the general interest of medicinal chemists and oncologists for metal-based compounds as candidate anti-CRC drugs. Within this frame, gold compounds and, specifically, the established antiarthritic drug auranofin with its analogs, form a novel group of promising anticancer agents. Owing to its innovative mechanism of action and its favorable pharmacological profile, auranofin together with its derivatives are proposed here as novel experimental agents for CRC treatment, capable of overcoming resistance to platinum drugs. Some encouraging results in this direction have already been obtained. A few recent studies demonstrate that the action of auranofin may be further potentiated through the preparation of suitable pharmaceutical formulations capable of protecting the gold pharmacophore from unselective reactivity or through the design of highly synergic drug combinations. The perspectives of the research in this field are outlined.

Smart E-Textile Systems: A Review for Healthcare Applications

E-textiles is a new hybrid field developed with the help of the integration of electronic components into our daily usage of textile products. These wearable e-textiles provide user-defined applications as well as normal textile clothing. The medical field is one of the major leading areas where these new hybrid products are being implemented, and relatively mature products can be observed in the laboratory as well as in commercial markets. These products are developed for continuous patient monitoring in large-scale hospital centers as well as for customized patient requirements. Meanwhile, these products are also being used for complex medical treatments and the replacement of conventional methods. This review manuscript contains a basic overview of e-textile systems, their components, applications, and usages in the field of medical innovations. E-textile systems, integrated into customized products for medical needs, are discussed with their proposed properties and limitations. Finally, some recommendations to enhance the e-textile system’s integration into the medical field are argued.

The Evolution of Peripheral Nerve Treatment for Trigeminal Neuralgia - Peripheral Injections

Trigeminal neuralgia presents as a characteristic severe painful condition that usually afflicts the area(s) innervated by the branches of the facial sensory nerves, especially the elderly females. The diagnosis can usually be made based solely on the presenting clinical signs and symptoms. Early literatures had revealed that there have always been two major means of treatment for trigeminal neuralgia; medical and surgical. Medical treatments involved systemic intake of various drugs or the topical applications of many different materials, not forgetting that bleeding and purging has been tried in the past. The introduction of anti-convulsants during the second World War had changed completely the way this painful condition was treated as this therapy later become the mainstay treatment for trigeminal neuralgia. Their beneficial effects, however may not be long lasting. This review summarises the evolution of peripheral nerve injection as a treatment for trigeminal neuralgia over the last 150 years.

IgG4-Related Disease Affecting Testicle and Myelodysplastic Syndrome: Just a Coincidence?

Immunoglobulin G4-related disease (IgG4-RD) is progressive immune-mediated fibrotic condition characterised by a tendency to form tumefactive lesions in different organs and by elevated IgG4 serum concentrations. Urological manifestations are rare and normally occur together with other systemic affections. Myelodysplastic syndromes (MDS) are hematopoietic stem cell neoplasms, with different subtypes based on the type of blood cells involved. MDS can be associated with other pathologies or medical treatments. We present an uncommon case of testicular manifestation associated with myelodysplastic syndrome here.

The Mathematical Model for searching the Shortest Route for TB Patients with the help of Dijkstra’s Algorithm

In this research paper, we have studied TB (Tuberculosis) patients who come from different traffic routes in order to seek medical help and treatment in Karachi, Sindh, Pakistan. In this research work, we have focused on the transportation problems of the TB patients. These TB patients can travel on the paths having minimum distance as found out in this paper using Dijktra’s Algorithm. People hope that they have better treatment opportunities and financial medical relief in the government and private hospitals in Karachi. There are many private hospitals in the city but unfortunately, they provide expensive treatments. As a consequence, people belonging to the poor or lower and middle classes approach government hospitals adequately. Among them, Nazimabad Chest Hospital for TB patients (under the supervision of Dow University of Health Sciences) is providing better facilities as compared to the other hospitals involved in providing medical treatments for the similar medical issues. Nazimabad Chest Hospital for TB patients is renowned for its high quality treatment of TB patients. The hospital is located inside Government Hospital Nazimabad (under the control of Dow University), Karachi. It has latest equipments, competent and qualified staff to treat TB patients. Patients have to visit the hospital on weekly basis from their homes and residences. They use several combinations of traffic routes to reach the hospital as these patients live in different areas like, Malir Cantt, Safari Park, Hassan Square, North-Nazimabad, North Karachi, Gulshan-e-Iqbal, etc. A path or road is required which takes the least amount of time and subsequently reduces the transportation charges. In this paper, an effort has been made to locate the shortest route for the convenience for these TB patients. In this paper, a mathematical model has been developed by using the method of Dijkstra’s algorithm to attain the desired objective.