Influence of Clinical Factors on the Quality of Life in Romanian People with Epilepsy-A Follow-Up Study in Real-Life Clinical Practice.

BACKGROUND: This study aimed to assess the influence of various clinical factors on the quality of life perception of patients with epilepsy over a follow-up period in current clinical practice. METHODS: Thirty-five PWE evaluated via video-electro-encephalography in the Clinical Hospital of Psychiatry and Neurology in Brasov, Romania, were included, and the quality of life was assessed using the Romanian version of the QOLIE-31-P questionnaire. RESULTS: At baseline, the mean age was 40.03 (±14.63) years; the mean duration of epilepsy was 11.46 (±12.90) years; the mean age at the first seizure was 28.57 (±18.72); and the mean duration between evaluations was 23.46 (±7.54) months. The mean (SD) QOLIE-31-P total score at the initial visit (68.54 ±15.89) was lower than the mean (SD) QOLIE-31-P total score at the follow-up (74.15 ± 17.09). Patients with epileptiform activity recorded via video-electro-encephalography, using polytherapy, those with uncontrolled seizures, and those with one or more seizures per month had statistically significantly lower QOLIE-31-P total scores at baseline and follow-up. Multiple linear regression analyses revealed seizure frequency as a significant inverse predictor of quality of life in both evaluations. CONCLUSIONS: The QOLIE-31-P total score was improved during the follow-up period, and medical professionals should use instruments to evaluate quality of life and identify patterns while trying to improve the outcomes of patients with epilepsy.

Thrombosis, an important piece in the COVID-19 puzzle: From pathophysiology to therapy.

A lot of data about coronavirus disease 2019 (COVID-19) have been already published; however, these still form only a part of the pandemic puzzle. Once we have all the pieces of the puzzle, we will be able to successfully treat this disease with its multiple challenges. COVID-19 has a high thrombogenic potential. In this study, we aimed to review published data about COVID-19 associated thrombosis from pathophysiology to treatment and the role in patient evolution. We searched for articles and studies published online through MEDLINE/PubMed database, Google Scholar, ScienceDirect, Wiley Online Library, and Nature Public Health Emergency Collection. We found numerous articles regarding COVID-19 infection but selected only those focused on thrombosis. D-dimers have a predictive value in identifying thrombosis and a high level correlates with the severity of the infection and death. Most patients who were on chronic anticoagulant therapy before contracting the virus had a better prognosis. Heparin has other favorable effects such as a direct antiviral and anti-inflammatory effect in addition to its anticoagulant effect. COVID-19 infections are frequently complicated by thrombotic pathology. High plasma level of D-dimers is a predictive factor for severe prognosis, and the recommended anticoagulant, associated with low mortality, is heparin followed by a direct oral anticoagulant. Randomized studies in large groups of patients and therapeutic guidelines are still needed on this subject.

Double-diffusion convective biomimetic flow of nanofluid in a complex divergent porous wavy medium under magnetic effects.

We explore the physical influence of magnetic field on double-diffusive convection in complex biomimetic (peristaltic) propulsion of nanofluid through a two-dimensional divergent channel. Additionally, porosity effects along with rheological properties of the fluid are also retained in the analysis. The mathematical model is developed by equations of continuity, momentum, energy, and mass concentration. First, scaling analysis is introduced to simplify the rheological equations in the wave frame of reference and then get the final form of equations after applying the low Reynolds number and lubrication approach. The obtained equations are solved analytically by using integration method. Physical interpretation of velocity, pressure gradient, pumping phenomena, trapping phenomena, heat, and mass transfer mechanisms are discussed in detail under magnetic and porous environment. The magnitude of velocity profile is reduced by increasing Grashof parameter. The bolus circulations disappeared from trapping phenomena for larger strength of magnetic and porosity medium. The magnitude of temperature profile and mass concentration are increasing by enhancing the Brownian motion parameter. This study can be productive in manufacturing non-uniform and divergent shapes of micro-lab-chip devices for thermal engineering, industrial, and medical technologies.

Biomolecular Evaluation of Lavandula stoechas L. for Nootropic Activity.

Lavandula Stoechas L. is widely known for its pharmacological properties. This study was performed to identify its biomolecules, which are responsible for enhancement of memory. L. stoechas aqueous extract was first purified by liquid column chromatography. The purified fractions were analyzed for in vitro anti-cholinesterase activity. The fraction that produced the best anti-cholinesterase activity was named an active fraction of L. stoechas (AfL.s). This was then subjected to GC-MS for identifications of biomolecules present in it. GC-MS indicated the presence of phenethylamine and α-tocopherol in AfL.s. Different doses of AfL.s were orally administered (for seven days) to scopolamine-induced hyper-amnesic albino mice and then behavioral studies were performed on mice for two days. After that, animals were sacrificed and their brains were isolated to perform the biochemical assay. Results of behavioral studies indicated that AfL.s improved the inflexion ratio in mice, which indicated improvement in retention behavior. Similarly, AfL.s significantly (p < 0.001) reduced acetylcholinesterase and malondialdehyde contents of mice brain, but on the other hand, it improved the level of choline acetyltransferase, catalase, superoxide dismutase, and glutathione. It was found that that high doses of AfL.s (≥400 mg/Kg/p.o.) produced hyper-activity, hyperstimulation, ataxia, seizures, and ultimate death in mice. Its LD50 was calculated as 325 mg/Kg/p.o. The study concludes that α-tocopherol and phenethylamine (a primary amine) present in L. stoechas enhance memory in animal models.

Trimetazidine Therapy in Coronary Artery Disease: The Impact on Oxidative Stress, Inflammation, Endothelial Dysfunction, and Long-Term Prognosis.

BACKGROUND: In coronary artery disease (CAD), reduction of perfusion in coronary arteries is followed by increases of oxidative stress and decreases of adenosine triphosphate reserve. In this condition, trimetazidine (TMZ), a metabolic anti-ischemic agent, seems to be an ideal therapeutic agent because it increases mitochondrial adenosine triphosphate production. STUDY QUESTION: To evaluate the impact of TMZ on oxidative stress, inflammation, endothelial dysfunction, and long-term prognosis in CAD. STUDY DESIGN: Patients with CAD with symptoms not adequately controlled were enrolled consecutively for a period of 18 months. MEASURES AND OUTCOMES: Five hundred seventy patients with CAD were enrolled in a prospective study and divided into 4 groups in relation with the type of CAD and the addition of TMZ to optimal medical therapy (OMT). The impact of TMZ added to OMT on oxidative stress (total antioxidant status, antioxidized low-density lipoprotein antibodies, and antimyeloperoxidase antibodies), endothelial dysfunction (flow-mediated dilatation and von Willebrand factor activity), and inflammation (C-reactive protein and fibrinogen) at 6 months and on long-term prognosis in CAD in comparison with OMT at 5 years of follow-up was evaluated. RESULTS: At 6 months, TMZ added to OMT significantly decreased the incidence of oxidative stress in CAD (P < 0.03) and reduced endothelial dysfunction and inflammation only in non-ST-elevation acute coronary syndrome (NSTE-ACS, P < 0.04). TMZ added to OMT with or without interventional/surgical vascularization led to decreased readmission for NSTE-ACS and heart failure (P < 0.05) in all patients with CAD and a significantly reduced incidence of cardiovascular death, acute myocardial infarction, and stroke (P < 0.05) in patients with NSTE-ACS at 5 years of follow-up. CONCLUSIONS: In patients with NSTE-ACS, TMZ added to OMT with or without interventional and/or surgical reperfusion reduced oxidative stress, endothelial dysfunction, inflammation, and major acute cardiovascular events, whereas in patients with chronic coronary syndrome, TMZ decreased oxidative stress and readmission for ACS and heart failure.

Cilia-assisted flow of viscoelastic fluid in a divergent channel under porosity effects.

Cilia-driven laminar flow of an incompressible viscoelastic fluid in a divergent channel has been conducted numerically using the BVP4C technique. The non-Newtonian Jeffrey rheological model is utilized to characterize the fluid. The flow equations are formulated in a curvilinear coordinate system, and the porosity effects are simulated with a body force term in the Navier-Stokes equation. The flow equations are transformed into a wave frame from a fixed frame of reference using a linear mathematical relationship. A biological approximation of creeping phenomena and the long-wavelength assumption is used in the flow analysis. The flow analysis is carried out by using a complex (wavy) propulsion of cilia beating. The two-dimensional flow is controlled by physical parameters-Darcy's number, curvature parameter, viscoelastic parameter, phase difference, cilia length, and divergent parameter. They also examined the ciliated pumping and bolus trapping in their flow analysis. The boundary layer phenomena in the velocity profile are noticed under more significant porosity and time relaxation effects. The bolus circulations are reduced for a larger porosity medium and larger numeric values of the time relaxation parameter.

Risk management strategies and therapeutic modalities to tackle COVID-19/SARS-CoV-2.

The recent emergence of novel coronavirus disease (COVID-19) triggered by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in substantial mortality worldwide. Presently, there is no approved treatment for COVID-19. Consequently, the clinical, scientific, and regulatory authorities have joint efforts to reduce the severe impact of COVID-19. To date, there is minimal arsenal with no definite curative drugs, licensed-vaccines, or therapeutic conducts to combat the COVID-19 infections. Keeping in view the threats of this pandemic, various global organizations, physicians, researchers, and scientists, are trying to recognize the epidemiological characteristics and pathogenic mechanisms of COVID-19 to discover potential treatment regimens, vaccines, and therapeutic modes for future anticipation. Herein, we summarize a contemporary overview of curative invasions and vaccines for COVID-19 based on the earlier information and considerate of similar earlier RNA coronaviruses. The information reviewed here establishes a paramount intellectual basis to promote ongoing research to develop vaccines and curative agents. Thus, this review suggests the furthermost accessible frontiers in the vaccine development to tackle or combat the COVID-19/SARS-CoV-2.

Are There Any Beneficial Effects of Spirulina Supplementation for Metabolic Syndrome Components in Postmenopausal Women?

Spirulina is a phytosynthetic filamentous cyanobacterium with microscopic dimensions, which naturally grows in the highly-salted alkaline lakes of Africa, Mexico, America, and Asia. Several bioactive peptides extracted from Spirulina were demonstrated to possess antimicrobial, antiviral, antitumor, immunomodulatory, antiallergic and antihypertensive properties. It has been reported that the consumption of Spirulina could prevent or manage metabolic syndrome components. In women, metabolic disorders are more prevalent during menopause. Postmenopausal women present higher waist circumference, increased blood pressure, hypertriglyceridemia, hyperglycemia, and decreased HDL-cholesterol values, leading to an increased risk of cardiovascular events. Therefore, in order to prevent cardiovascular diseases, it is essential to manage the components of the metabolic syndrome during the postmenopausal period. As recent reports indicated the efficiency of Spirulina supplementation in the management of the metabolic syndrome components, our study aims to review all the clinical trials conducted on this topic. Our main objective is to have a better understanding of whether and how this cyanobacterium could manage the abnormalities included in the metabolic syndrome and if it could be used as a therapeutic approach in postmenopausal women with this condition. We selected relevant articles from PubMed, Google Scholar and CrossRef databases, and a total number of 20 studies met our criteria. All included clinical trials indicated that Spirulina has positive effects in managing metabolic syndrome components. Spirulina is a valuable cyanobacterium that can be used as a food supplement for the management of metabolic syndrome, and it is able to reduce the risk of cardiovascular events. The optimal dose and period of administration remain a debated subject, and future investigations are required. Considering the beneficial effects reported against each component of the metabolic syndrome, Spirulina could also be effective in the postmenopausal period, when this syndrome is the most prevalent, but there is a strong need for human clinical trials in order to sustain this observation.

Ex vivo and in vivo studies of Viola tricolor Linn. as potential cardio protective and hypotensive agent: Inhibition of voltage-gated Ca++ ion channels.

Viola tricolor Linn. is used as cardio-protective and anti-hypertensive agent in traditional medicine. Current study objective was to evaluate cardio-protective and hypotensive effects of Viola tricolor L. in vitro and in vivo studies. Viola tricolor L. crude extract (Vt.Cr) and its fractions (Aqueous and organic) were tested at rabbit atria and aorta coupled to Power Lab Data Acquisition System for cardio depressant and vasorelaxant effects in vitro whereas in vivo Blood Pressure was checked by invasive method in normotensive ketamine-diazepam anesthetized rats. Isoproterenol was employed for acute myocardial infarction (AMI) and left ventricular hypertrophy (LVH) development and cardioprotective effects of Vt.Cr were evaluated hemodynamically and histopathologically. Vt.Cr and its fractions decreased heart rate and contractile force in paired atria and relaxed Phenylephrine (1 µM) and K+ (80 mM) stimulated contractions in aorta possibly mediated through Voltage dependent L-type calcium channels blockage supported by in vivo hypotensive action. In LVH, Vt.Cr lowered Angiotensin Converting Enzymes and renin, increased cyclic Guanosine Monophosphate and nitric oxide levels, decreased cardiomyocytes size and fibrosis attributed to Gallic acid as detected by High Performance Liquid Chromatography. Partial positive results were seen hemodynamically and histologically in AMI Viola tricolor L. showed vasorelaxant, cardio-relaxant, hypotensive, and cardio protective effect validating traditional practice in cardiovascular disorders.

Low Response to Clopidogrel in Coronary Artery Disease.

BACKGROUND: In patients with coronary artery disease, cardiovascular mortality and other acute events showed a clear correlation with risk factors and biomarkers including platelet activation. STUDY QUESTION OF THIS RESEARCH: Which was the incidence of low response to clopidogrel and its correlation with risk factors and biomarkers in coronary artery disease? STUDY DESIGN: Four hundred patients (pts) with coronary artery disease-stable angina (SA) and acute coronary syndrome-were divided into 8 groups of study, consistent with low response to clopidogrel and the type of coronary artery disease. Low response to clopidogrel-defined as adenosine diphosphate test-ADP-test of >46 U by multiple electrode platelet aggregometry was evaluated in correlation with cardiovascular risk factors and biomarkers of oxidative stress, endothelial dysfunction, hypercoagulability, high platelet reactivity. RESULTS: In coronary artery disease, low response to clopidogrel significantly correlated with older than 65 years, smoking, hypertension, diabetes mellitus, body mass index of >25, previous aspirin treatment (P < 0.05), high value of total and low-density lipoprotein cholesterol, low value of high-density lipoprotein cholesterol, low response to aspirin, high mean platelets volume and von Willebrand factor activity, low flow-mediated vasodilatation, total antioxidant status (P < 0.01) and only in patients with SA of male gender (P < 0.01). The incidence of other hypercoagulability biomarkers, such as reduced values of S protein, C protein, antithrombin III, and V Factor Leiden resistance to activated protein C, was very low and not correlated with low response to clopidogrel. CONCLUSIONS: In coronary artery disease, low response to clopidogrel significantly correlated with the most of old cardiovascular risk factors, with previous aspirin treatment, low response to aspirin, higher mean platelets volume, higher von Willebrand factor activity, lower flow-mediated vasodilatation, and lower total antioxidant status values and only in patients with SA of male gender.

Correlation of Cardiovascular Risk Factors and Biomarkers With Platelet Reactivity in Coronary Artery Disease.

BACKGROUND: Low response to aspirin, aspirin resistance, and high platelet reactivity on aspirin treatment are similar names for lack of response to block arachidonic acid-induced aggregation with aspirin therapy and have an important role in the evolution of coronary artery disease (CAD) with thromboembolic events. STUDY QUESTION: Was to evaluate the correlation between cardiovascular risk factors, biomarkers, and low response to aspirin in patients (pts) with CAD. STUDY DESIGN: Four hundred pts with CAD were divided into 8 groups of study, consistent with the type of CAD and low response to aspirin. Cardiovascular risk factors and biomarkers-including some of high platelet reactivity, endothelial dysfunction, hypercoagulability, and oxidative stress-were evaluated in correlation with low response to aspirin, defined as on treatment aspirin test (ASPItest) >30U by multiple electrode platelet aggregometry. RESULTS: In patients with CAD, low response to aspirin was significantly correlated with age older than 65 years, smoking, presence of diabetes mellitus, body mass index >25, hypertension, previous aspirin treatment, low response to clopidogrel, high mean platelets volume and von Willebrand factor activity, low flow-mediated vasodilation, and total antioxidant status (P < 0.01). In unstable angina patients, low response to aspirin was significantly correlated with male sex (P < 0.03). Incidence of other hypercoagulability biomarkers-S Protein, C Protein, Antithrombin III, and V Factor Leiden resistance to activated protein C-was low and not correlated with low response to aspirin. CONCLUSIONS: In CAD, low response to aspirin was significantly correlated with age older than 65 years, smoking, presence of diabetes mellitus, body mass index I >25, hypertension, previous aspirin treatment, and only in unstable angina with male sex. Low response to aspirin was also statistically associated with low response to clopidogrel, high mean platelets volume, high von Willebrand factor activity, low flow-mediated vasodilation, and low total antioxidant status values.

Rovamycine as add-on treatment in unstable angina and 4 year evolution with major cardiovascular events.

BACKGROUND: Major antibiotic trials targeting Chlamydia Pneumoniae or the pathogen burden in acute coronary syndromes reported conflicting data. Only a minor impact of antibiotic treatment on major cardiovascular events (MACE) incidence was demonstrated in some studies. METHODS AND RESULTS: 109 unstable angina patients were randomised in: group C receiving conventional treatment, group R treated with Rovamycine 12 days 4.5 MUI iv /day as add-on therapy, group R1 treated with Rovamycine 12 days 4.5 MUI iv/day followed by 6 MUI/day per os for another 12 days add on treatment. Randomisation into the therapeutical groups was independent of the serological status for Chlamydia pneumoniae. The primary adverse end-points of the study were the incidence of major cardiovascular events at 3 months, 6 months and at 4 years and the 4 years cumulated end-point rate. Secondary adverse end-points were the incidence of recurrent stable angina at 3 and 6 months and the incidence of increased serum levels of C reactive protein and fibrinogen at 3 and 6 months. Statistics used multiple regression analysis and Chi square test. At 6 months the incidence of unstable angina with readmission was significantly lower in groups R and R1 compared to group C (p < 0.001, respective p < 0.0001) and significantly lower in group R1 compared to group R (p < 0.0001). The incidence of nonfatal myocardial infarction at 6 months was significantly lower in groups R and R1 compared to group C (p < 0.0001). The incidence of cardiovascular death was significantly lower in group R1 compared to group C and R (p < 0.001). At 4 years the incidence of unstable angina with readmission and the cumulated end point rate were significantly reduced in groups R and R1 compared to group C. The 3 months incidence of increased serum levels of C reactive protein was significantly decreased in group R1 compared to groups C and R (p<0.001). The 3 months incidence of increased serum levels of fibrinogen was significantly lower in groups R and R1 compared to group C (p<0.002, respectively p<0.001). CONCLUSIONS: In patients with unstable angina Rovamycine as add-on treatment to the conventional treatment lead to a significant decrease of MACE incidence at 6 months and to a significant decrease in the 4 years incidence of unstable angina with readmission. The beneficial effect of Rovamycine was parallel to the decrease in serum inflammations markers concentration.