Circular RNAs in Intervertebral Disc Degeneration: An Updated Review

Low back pain, a common medical condition, could result in severe disability and inflict huge economical and public health burden. Its pathogenesis is attributed to multiple etiological factors, including intervertebral disc degeneration (IDD). Emerging evidence suggests that circular RNAs (circRNAs), a major type of regulatory non-coding RNA, play critical roles in cellular processes that are pertinent to IDD development, including nucleus pulposus cell proliferation and apoptosis as well as extracellular matrix deposition. Increasing number of translational studies also indicated that circRNAs could serve as novel biomarkers for the diagnosis of IDD and/or predicting its clinical outcomes. Our review aims to discuss the recent progress in the functions and mechanisms of newly discovered IDD-related circRNAs.

Graphene-Based Materials Prove to Be a Promising Candidate for Nerve Regeneration Following Peripheral Nerve Injury

Peripheral nerve injury is a common medical condition that has a great impact on patient quality of life. Currently, surgical management is considered to be a gold standard first-line treatment; however, is often not successful and requires further surgical procedures. Commercially available FDA- and CE- approved decellularized nerve conduits offer considerable benefits to patients suffering from a completely transected nerve but they fail to support neural regeneration in gaps >30 mm. To address this unmet clinical need, current research is focused on biomaterial-based therapies to regenerate dysfunctional neural tissues, specifically damaged peripheral nerve, and spinal cord. Recently, attention has been paid to the capability of graphene-based materials (GBMs) to develop bifunctional scaffolds for promoting nerve regeneration, often via supporting enhanced neural differentiation. The unique features of GBMs have been applied to fabricate an electroactive conductive surface in order to direct stem cells and improve neural proliferation and differentiation. The use of GBMs for nerve tissue engineering (NTE) is considered an emerging technology bringing hope to peripheral nerve injury repair, with some products already in preclinical stages. This review assesses the last six years of research in the field of GBMs application in NTE, focusing on the fabrication and effects of GBMs for neurogenesis in various scaffold forms, including electrospun fibres, films, hydrogels, foams, 3D printing, and bioprinting.

Rhabdomyolysis-induced acute kidney injury in a patient with non-compliance to levothyroxine therapy

Summary Hypothyroidism is a common medical condition and is often easily managed with excellent outcomes, when treated adequately. Compliance with levothyroxine (LT4) therapy is often compromised because of the need for a daily and lasting schedule. Overt rhabdomyolysis due to under-treatment or non-compliance is a rare occurrence. We report a case of rhabdomyolysis leading to acute kidney injury (AKI) on chronic kidney disease (CKD) requiring hemodialysis (HD) in a 68-year-old Caucasian male due to non-compliance with levothyroxine (LT4) therapy. Our patient 'ran out of levothyroxine' for approximately 4 weeks and developed gradually progressive muscle pain. The diagnosis of severe AKI due to rhabdomyolysis was made based on oliguria, elevated creatinine kinase (CK), and renal failure. Resuming the home dose of LT4 failed to correct CK levels, and there was a progressive decline in renal function. Although increasing doses of LT4 and three cycles of HD improved CK levels, they remained above baseline at the time of discharge. The patient recovered gradually and required HD for 4 weeks. CK levels normalized at 6 weeks. Through this case report, we highlight that non-compliance with LT4 therapy can lead to life-threatening complications such as renal failure and hence the need to educate patients on the significance of compliance with LT4 therapy should be addressed. Learning points Non-compliance to levothyroxine therapy is common and can lead to serious complications, including rhabdomyolysis. Rhabdomyolysis is an uncommon presentation of hypothyroidism and severe rhabdomyolysis can result in renal failure requiring hemodialysis. Rhabdomyolysis associated with hypothyroidism can be further exacerbated by concomitant use of statins.

A De Novo Pharmacist-Family Physician Collaboration Model in a Family Medicine Clinic in Alberta, Canada

Collaborative practice in health-care has proven to be an effective and efficient method for the management of chronic diseases. This study describes a de novo collaborative practice between a pharmacist and a family physician. The primary objective of the study is to describe the collaboration model between a pharmacist and family physician. The secondary objective is to describe the pharmacist workload. A list of patients who had at least one interaction with the pharmacist was generated and printed from the electronic medical record. There were 389 patients on the patient panel. The pharmacist had at least one encounter with 159 patients. There were 83 females. The most common medical condition seen by the pharmacist was hypertension. A total of 583 patient consultations were made by the pharmacist and 219 of those were independent visits. The pharmacist wrote 1361 prescriptions. The expanded scope of practice for pharmacists in Alberta includes additional prescribing authority. The pharmacists’ education and clinical experience gained trust from the family physician. These, coupled with the family physician’s previous positive experience working with pharmacists made the collaboration achievable.

May-Thurner Syndrome, an Often Overlooked Cause of Deep Vein Thrombosis: A Case Report

Deep vein thrombosis (DVT) is a common medical condition, but the predisposing anatomical factors, which may be amenable to definitive treatment, are usually overlooked. Therefore, a high index of clinical suspicion is the key to early diagnosis. We report here one such case of May-Thurner syndrome (MTS) to raise awareness. MTS (also known as iliac vein compression syndrome) should be suspected in cases of extensive DVT of the leg, particularly involving the iliac vein on the left side. The prognosis is improved with thrombolysis followed by angioplasty and stent to address the venous stenosis.

Expression of Androgen Receptors in Abating Age-Related Temporomandibular Muscles Dysfunctions in Female Albino Wistar Rats

Dysfunctions of Muscles of Mastication (MM) are commonly associated with facial pain, and it is a common medical condition in women's reproductive health. Hypothetically, sex hormones could be considered an underlying cause for this dysfunction, but few studies were done to explore sex hormones receptors in MM. The aim of the present study is to explore the effect of both age and sex on the expression of estrogen and androgen receptors in muscles of mastication. Eighty rats were randomly assigned into four groups. Group-12F, group-12M, group-24F and group-24M. After rats were sacrificed, MM were removed for histological and immunohistochemical examinations. Regardless age and sex, there was a weak expression of estrogen receptors (α,β) in all muscles. In group-24M, expression of androgen receptors in MM was significantly higher than that of other groups. In conclusion, the present study sheds the light on the age-related increased expression of androgen receptors in male albino wistar rats which could protect against temporomandibular muscles dysfunctions. Further studies are needed to evaluate this hypothesis for further clinical applications.

Formulation and Standardization of Polyherbal Antihyperlipidemic Formulation

Hyperlipidemia is a very common medical condition. A fairly less invasive, more effective and efficient method with lower or no side effects to treat Hyperlipidemia are to be developed. Thus, use of traditional herbal medication can be a relevant solution to it. Development of highly standardized Polyherbal formulation with respect to chemical content and therapeutic activity is considered as a valuable approach in the field of herbal industry. Traditional medicine is known for its Polyherbal contents and multicomponent therapeutics for managing health problems. Thus, the present research is focused on to formulate, standardize a polyherbal medicine to treat hyperlipidemia and also compared its chemical contents based on, geographical, seasonal variations using standard physio-chemical parameters such as Ash values, Extractive values, pH, and loss on drying, Particle size analysis and physical analysis of powder formulation. HPTLC fingerprinting, with markers such as Gallic acid, Quercetin, Gymnemic acid, and Mahanine were carried out. In addition, residue analysis such as heavy metal content, microbial load, pesticide analysis, aflotoxin determination were also carried out to strengthen the standardization process and to ensure safety.

Management of non-alcoholic fatty liver disease

ABSTRACT Non-alcoholic fatty liver disease is a very common medical condition, driven by a combination of genetic and lifestyle factors, ultimately producing a severe chronic liver disease and increased cardiovascular risk. Most people are asymptomatic for a long time, and their daily life is unaffected, leading to difficulty in identifying and managing people who slowly progress to non-alcoholic steatohepatitis (NASH), NASH-cirrhosis, and eventually hepatocellular carcinoma. Despite advances in the understanding of pathogenic mechanisms and the identification of liver fibrosis as the strongest factor in predicting disease progression, no specific treatments have been approved by regulatory agencies. Outside controlled trials, treatment is generally limited to lifestyle intervention aimed at weight loss. Pioglitazone remains the drug of choice to reduce progression of fibrosis in people with diabetes, although it is often used off-label in the absence of diabetes. Vitamin E is mainly used in children and may be considered in adults without diabetes. Several drugs are under investigation according to the agreed targets of reduced NASH activity without worsening of fibrosis or improving fibrosis without worsening of NASH. Anti-inflammatory, anti-fibrotic agents and metabolism modulators have been tested in either phase III or phase IIb randomized controlled trials; a few failed, and others have produced marginally positive results, but only a few are being tested in extension studies. The development of non-invasive, easily repeatable surrogate biomarkers and/or imaging tools is crucial to facilitate clinical studies and limit liver biopsy.

Trends of antimicrobial resistance in Escherichia coli isolates from urine cultures of women in Jordan: A 10-year retrospective study

Background: Urinary tract infection (UTI) is a common medical condition among women. E.coli is the most common causative organism. Appropriate understanding of the development of antimicrobial resistance over the past helps to establish efficient treatment strategies in the future. The study aims to discover antimicrobial resistance trends exhibited by E.coli strains isolated from women urine cultures over the past 10 years. Methods: A total of 1874 affected urine samples over the years 2009 to 2018 were collectively reviewed and classified according to the response they showed to 24 different antimicrobial disks in the laboratory. Relations between time and resistance evolutionary profiles were calculated. Results: Gentamicin (p value =0.039), Augmentin (p value =0.017), Cefoxitin (p value =0.001), Cefixime (p value =0.026) fulfilled satisfactory figures in terms of average resistance, regression of resistance, speed of resistance evolution, steadiness of performance, side effects, spectrum range and cost with high significance. Conclusion: Drugs that showed satisfactory figures are recommended for future treatment protocols in Jordan.

Cannabinoids for People with ASD: A Systematic Review of Published and Ongoing Studies

The etiopathogenesis of autism spectrum disorder (ASD) remains largely unclear. Among other biological hypotheses, researchers have evidenced an imbalance in the endocannabinoid (eCB) system, which regulates some functions typically impaired in ASD, such as emotional responses and social interaction. Additionally, cannabidiol (CBD), the non-intoxicating component of Cannabis sativa, was recently approved for treatment-resistant epilepsy. Epilepsy represents a common medical condition in people with ASD. Additionally, the two conditions share some neuropathological mechanisms, particularly GABAergic dysfunctions. Hence, it was hypothesized that cannabinoids could be useful in improving ASD symptoms. Our systematic review was conducted according to the PRISMA guidelines and aimed to summarize the literature regarding the use of cannabinoids in ASD. After searching in Web of KnowledgeTM, PsycINFO, and Embase, we included ten studies (eight papers and two abstracts). Four ongoing trials were retrieved in ClinicalTrials.gov. The findings were promising, as cannabinoids appeared to improve some ASD-associated symptoms, such as problem behaviors, sleep problems, and hyperactivity, with limited cardiac and metabolic side effects. Conversely, the knowledge of their effects on ASD core symptoms is scarce. Interestingly, cannabinoids generally allowed to reduce the number of prescribed medications and decreased the frequency of seizures in patients with comorbid epilepsy. Mechanisms of action could be linked to the excitatory/inhibitory imbalance found in people with ASD. However, further trials with better characterization and homogenization of samples, and well-defined outcomes should be implemented.