Cardiovascular & Haematological Disorders - Drug Targets - Volume 22, Issue 1, 2022

Background: Patients with hemophilia have a hypocoagulable state and less chances of thrombus formation. Therefore, they are expected to have a lower cardiovascular mortality than the general population. The lower cardiovascular mortality can be explained by less chances of thrombus formation due to hypocoagulability. Case Presentation: Here, we present a case of a 42-year-old male patient who presented with severe chest pain radiating to the back for 4 days. ECG was suggestive of recent acute anteroseptal myocardial infarction. There was a history of receiving intravenous recombinant factor VIII, 1 hour prior to the onset of chest pain for knee joint swelling. The occurrence of acute coronary syndromes in patients with hemophilia A is uncommon and rarely reported. Conclusion: Here, we report a patient with severe hemophilia A who developed acute myocardial infarction after administration of recombinant factor VIII.

Background: Haematological manifestations in Hepatitis C virus (HCV) infection have been uncommon since the advent of direct-acting antiviral drugs (DAAs). However, primary HCV infection can cause significant haematological disease in the form of various autoimmune cytopenias. Case Presentation: We herein discuss a 68-years-old female with chronic HCV infection for the last 15 years (not on the treatment), who presented with complaints of progressive fatigue, exertional dyspnea, and increased abdominal distention over the previous 20 days. Coombs-positive autoimmune haemolytic anaemia (AIHA) was diagnosed based on the haematological evaluation (raised lactate dehydrogenase, indirect bilirubinemia, raised reticulocyte count and direct Coombs positive). The patient showed significant improvement in haematological indices with oral prednisolone. However, she eventually succumbed to her illness due to underlying decompensated liver disease. HCV infection may associate with global derangement of the immune system, which is likely to cause AIHA. Diagnosis of autoimmune cytopenias can be easily missed in HCV positive patients due to underlying decompensated liver disease and portal hypertension. Conclusion: Thus, screening of HCV infection is imperative in every patient of AIHA, especially with the high worldwide prevalence of HCV.

Background: Direct oral anticoagulants (DOACs) carry a lower potential risk of food/herb and drug interactions compared to oral vitamin K antagonists. However, as a new class of medications, drug interactions of DOACs have not been fully known. Case Presentation: We herein present the case of a 64-year old male with the complaint of acute onset epistaxis and bleeding gums following the concomitant use of rivaroxaban and saffron supplement. It seems that coadministration of DOACs and saffron supplements should be avoided due to the potential drug-herbal interactions and possible risk of subsequent bleeding complications. Conclusion: However, further larger-scale surveillance studies are needed to confirm the findings and assess the clinical significance.

Introduction: Parotid swellings are commonly encountered in ENT clinics, the cause of which could range from neural conditions, endocrine problems, vitamin deficiencies, and sialadenitis, which may even be a manifestation of an underlying systemic disease. Multiple myeloma represents a clonal proliferation of plasma cells and is a condition in which a parotid swelling might be present, although very uncommon. Case presentation: We report a case of a 60-year-old female who was presented with unilateral parotid swelling, which led to a diagnosis of multiple myeloma based on the investigations. Conclusion: Various imaging modalities are currently available to assess the extent of the swelling and evaluate the soft tissue and osseous involvement. The clinician must have a rigorous insight into the several clinical manifestations and the sites of involvement of the different conditions to make a proper diagnosis.

Aims: The study aimed to assess the antihyperglycemic activity of Pelargonium graveolens. Background: Pelargonium graveolens (P. graveolens) (Geraniaceae) is a medicinal plant frequently used in traditional medicine in Morocco and Algeria as a remedy against a multitude of illnesses. Interestingly, it is also used in the Moroccan pharmacopeia for managing diabetes. Objective: The current study was carried out in order to assess the antihyperglycemic activity of P. graveolens in normal and streptozotocin(STZ)-induced diabetic rats, as well as to evaluate the acute toxicity of the aqueous extract of leaves of Pelargonium graveolens (PGLAE). Methods: The therapeutic effect of PGLAE at a dose of 40 mg/kg on blood glucose levels was investigated in normal and STZ-induced diabetic rats after a single oral (6h) and a repeated (15 days) oral administration. The acute toxicity of the PGLAE was examined in accordance with the OECD test guideline. Post-treatment, body weight, signs of toxicity, and/or mortality were observed for 14 days. Further assays, such as the oral glucose tolerance test, histopathological examination, and antioxidant activity, were also performed according to standard protocols. Results: Findings exhibited that both single and repeated oral doses of PGLAE (40 mg/kg) caused a significant reduction in blood glucose levels of normal and diabetic rats. All treated animals survived and no apparent adverse effects were observed during the duration of the acute toxicity study. Importantly, oral LD50 of PGLAE was greater than 2000 mg/kg BW. Furthermore, a remarkable influence on glucose tolerance was also noticed after PGLAE treatment. Moreover, PGLAE was able to improve the histopathological structure of the liver and possesses a potential antioxidant effect in vitro. Conclusion: In conclusion, this study reported the antidiabetic effects of PGLAE in rats, supporting its traditional use for the management of diabetes.

Aims: The aim of the study was to assess the antihypertensive activity of Hibiscus rosasinensis. Background: Hibiscus rosa-sinensis is used traditionally to treat hypertension. Objective: The goal of the study was to investigate the effect of the aqueous extract of Hibiscus rosa- sinensis flowers (AEHRS) on resting blood pressure in rats. Methods: In the present study, AEHRS was prepared, and its antihypertensive activity was evaluated using in vivo and in vitro studies. In the in vivo study, hypertensive and normotensive rats were treated by AEHRS (100 mg/kg) orally for 6 hours in the acute treatment and for 7 days in the subchronic treatment. Systolic, diastolic, and mean arterial blood pressure values and heart rate were then recorded using a tail-cuff and a computer-assisted monitoring device. To assess the vasorelaxant activity of AEHRS, isolated thoracic aortic rings were suspended in a tissue bath, and changes in tension were recorded using a data acquisition system. Potential pathways involved in the vasorelaxant activity were evaluated using several standard pharmacological agents. Results: The results indicated that repeated oral administration of AEHRS during 7 days lowered systolic, diastolic, and mean arterial blood pressure in hypertensive rats without affecting normotensive rats. Furthermore, the data revealed that AEHRS exerts vasorelaxant properties via an endothelium- independent pathway. More interestingly, the study demonstrates that the vasorelaxant capacity of AEHRS seems to be exerted through the stimulation of angiotensin-converting enzyme-2 (ACE-2) and the inhibition of Ca²⁺ channels pathway. Conclusion: The present study revealed that aqueous extract of Hibiscus rosa-sinensis has a significant antihypertensive activity and that its vasorelaxant effect may be mediated through stimulation of ACE-2, and inhibition of the Ca²⁺ channels.

Background: Sacubitril/valsartan has revealed superior glycemic and blood pressure control compared with enalapril and irbesartan in patients with heart failure and type 2 diabetes and in individuals with chronic kidney disease. However, whether the effects of sacubitril/valsartan remain the same in those without heart failure is unknown. Methods: A multicenter randomized double-blinded trial will be carried out in five military hospitals in Taiwan for a period of 1 year. Participants with prior cardiovascular diseases and heart failure will be excluded. The purpose of the study is to compare the effects of sacubitril/valsartan (97/103 mg once or twice daily) on the temporal changes in fasting blood glucose, HbA1c, insulin resistance, and blood pressure levels with telmisartan (40 mg once or twice daily) in individuals with stage 1-3 hypertension and newly diagnosed type 2 diabetes or prediabetes who have an HbA1c ≥6.0% and a systolic blood pressure ≥130 mmHg or a diastolic blood pressure ≥85 mmHg. The inclusion criteria include the age of 35-70 years, women who are not pregnant, estimated glomerular filtration rate ≥45 ml/min per 1.73m², and B-type natriuretic peptide levels <400 pg/ml. Results: The sample size is estimated to be 502 participants for randomization according to an assumption of between-person standard deviation in systolic blood pressure of 15 mmHg or in HbA1c of 1.5%, which provides ≥80% power (at p =0.05) to detect a difference in systolic blood pressure of 4 mmHg or in HbA1c of 0.3% at the final follow-up. All participants will receive a comprehensive physical examination and tests for blood cell counts, blood biochemistry, urine analysis, 12-lead electrocardiography, and an echocardiography every 3 months. Conclusion: All analyses will be performed based on the intention-to-treat principle among all randomized participants.

Aims: The study aimed to assess the antidiabetic effect of oakmoss. Background: Lichens species are dual organisms consisting of a mycobiont (Fungi) and a photoautotrophic partner (Algae). They are widely used in traditional medicine as a treatment for diabetes. Objective: This study was designed to assess the antihyperglycemic activity as well as the antihyperlipidemic capacity of oakmoss (Evernia prunastri (L.)) in normal and streptozotocin(STZ)- induced diabetic rats. Methods: This study has evaluated the effects of aqueous extract of oakmoss at a dose of 60 mg/kg on blood glucose levels and lipid profile in normal and STZ-induced diabetic rats. Histopathological examination of the liver, determination of glycogen content in liver and skeletal muscles (EDL and soleus), antioxidant activity, and phytochemical investigation were also performed. Results: Both single and repeated oral doses of oakmoss (60 mg/kg) significantly reduced blood glucose, triglycerides, and very-low-density lipoprotein (VLDL) levels in diabetic rats. Furthermore, repeated oral administration of oakmoss for 7 days ameliorated the liver function by increasing its glycogen content and improving its histological architecture in treated diabetic rats. In addition, the aqueous extract of oakmoss exhibited antioxidant activity and showed richness in certain phytochemicals, especially in phenolic acids and flavonoids. Conclusion: Oakmoss, a lichen species, exhibits a potential effect on improving hyperglycemia and hypertriglyceridemia in diabetic rats.

Background: A better identification of the role of vitamin D in the thrombotic process of the acute coronary syndrome (ACS) will help increase the therapeutic options for this important clinical condition. There is little published evidence that 25-hydroxy vitamin D (25(OH)D) serum levels can associate with platelet function and risk of thrombosis. Methods: This prospective study was conducted on 200 patients with a diagnosis of ACS, including patients with unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). In addition to demographics and angiographic data, serum concentrations of 25(OH)D and MPV were recorded in all patients. Results: The types of ACS were STEMI (35%), NSTEMI (25%), and UA (40%). The concentrations of 25(OH)D in patients with UA, NSTEMI, and STEMI were 23.53 ± 13.26, 19.25 ± 8.09 and 14.60 ± 8.24 ng/mL respectively (P < 0.001), and the values of MPV were 9.83 ± 1.35, 10.30 ± 1.21, and 11.56 ± 1.38 fL, respectively (P < 0.001). There was a negative correlation between 25(OH)D and MPV (R = -0.320, P < 0.0001). ROC analysis illustrated a moderate predictive value (AUC 0.706; 95% CI, 0.63–0.72) in identifying the discrimination threshold of MPV (≥ 9.90 fL) for vitamin D deficiency (<20 ng/mL). Conclusion: The current study shows an inverse association between MPV and vitamin D levels in ACS patients, especially in the subgroup of STEMI. These findings propose the effect of vitamin D on platelet size and function, suggesting its role in thrombosis and hemostasis, which might explain the link between vitamin D deficiency and cardiovascular diseases.

Aims: The present work aimed to assess the antihyperglycemic and antihyperlipidemic effects of Moricandia suffruticosa. Background: Moricandia suffruticosa (M. suffruticosa) is used in traditional medicine. Objective: The present study investigated the antihyperglycemic and antidyslipidemic effects of M. suffruticosa and its effect on glycogen content in normoglycemic and hyperglycemic rats. Methods: The effect of the aqueous extract of M. suffruticosa (AEMS) at two doses of 100 and 140 mg/kg on blood glucose levels, lipid, lipoprotein profile, and glycogen content was examined in normal and streptozotocin (STZ)-induced diabetic rats. Moreover, preliminary phytochemical screening and quantification of phenolic, flavonoid, and tannin contents were carried out. Results: The results demonstrated that AEMS exhibits antihyperglycemic activity in diabetic rats during both acute and subchronic assays. Furthermore, AEMS revealed an antidyslipidemic effect concerning the level of triglycerides, total cholesterol, very-low-density lipoprotein (VLDL), and non-high-density lipoproteins (Non-HDL). In contrast, AEMS has not affected the value of glycemia, lipids, and lipoproteins in normal rats. In addition, AEMS is rich in several phytochemical compounds. Furthermore, AEMS revealed an important in vitro antioxidant activity. Conclusion: In conclusion, the study demonstrates that M. suffruticosa exhibits an important antihyperglycemic effect in diabetic rats.

Aims: The aim of the study was to assess the antihypertensive activity of Rumex vesicarius. Background: The genus Rumex (sorrel, Polygonaceae), containing approximately 200 species, is distributed worldwide (African, European, Asian, and American countries). It is widely used in traditional medicine as analgesic, diuretic, antispasmodic, and antihypertensive plant. Objectives: This study aimed to assess the possible antihypertensive vasorelaxant capacity and effect on angiotensin-converting enzyme 2 (ACE-2) of the aqueous extract of Rumex vesicarius (R. vesicarius). Methods: In the present study, the aqueous extract of R. vesicarius (AERV) was prepared, its antihypertensive activity was examined in N(ω)-nitro-L-arginine methyl ester(L-NAME)-induced hypertensive rats, and its vasorelaxant ability along with its effect on stimulating or inhibiting ACE-2 were determined in isolated rat thoracic aorta. Results: The results indicated that AERV decreased the systolic, diastolic, mean, and mean arterial blood pressure in hypertensive rats. The data revealed that AERV exerted its antihypertensive effect through vasodilatory properties via an endothelium-independent pathway. Interestingly, the study demonstrated that the vasorelaxation ability of AERV might be mediated through receptor-operated calcium channels (ROCC). However, AERV extract had no effect on either stimulating or inhibiting ACE-2. Conclusion: The present study demonstrates clearly the antihypertensive and vasorelaxant activities of R. vesicarius in hypertensive rats, supporting its beneficial action as an antihypertensive agent.