Citalopram & escitalopram: Mechanisms of cardiotoxicity, toxicology predisposition and risks of use in geriatric & hemodialysis populations.

The selective serotonin reuptake inhibitors (SSRIs) citalopram and escitalopram are extensively prescribed for various psychopathies. Despite their reputation for safety compared to older antidepressants, concerns have arisen regarding their cardiotoxic potential, notably in prolonging the QTc interval. In this comprehensive review, we investigate the intricate mechanisms of cardiotoxicity induction by citalopram/escitalopram, with a special focus on their interactions with ion channels like Kv11.1, Nav1.5, and Cav1.2 which may contribute to QTc-prolongation, increasing the risk of life-threatening arrhythmias such as Torsades de Pointes (TdP). Moreover, we explore the predisposing factors to their associated cardiotoxicity along with an investigation of the QRS/QTc ratio as a potential biomarker for identifying patients at risk of ventricular arrhythmias, taking into consideration the impact of genetic variations and drug interactions, especially those involving the liver CYP2C19 metabolism. Our review extends to the geriatric population's use of citalopram and escitalopram, emphasizing the significance of assessing a patient's medical history and cumulative drug use to evaluate their susceptibility to cardiac adverse events. Finally, we scrutinize the compound relationship between QTc-prolongation, proton pump inhibitors (PPIs) and serum-to-dialysate potassium gradients in influencing the proarrhythmic potential of citalopram/escitalopram in hemodialysis patients.

The effect of resection of gliomas of the primary motor and sensory cortex on functional recovery and seizure outcome: A 10-year retrospective study.

Background: Gliomas, the most common primary brain tumors, pose surgical challenges in eloquent cortex regions due to potential deficits affecting patients' quality of life (QOL) and increased mortality risk. This study investigates motor and sensory recovery postresection of Rolandic cortex gliomas in 40 patients, alongside seizure outcomes and the efficacy of intraoperative techniques such as awake craniotomy. Methods: This was a 10-year monocentric retrospective study based on the experience of a neurosurgeon in the resection of Rolandic gliomas and its impact on 40 patients' QOL in a period from 2011 to 2020. The primary outcomes were tumor recurrence and the efficacy of the surgery defined as survival status, seizure status, and sensory and motor neurological deficits. Data collection included demographic, tumor, and surgical outcome variables. The extent of resection (EOR) was classified as gross total resection (GTR) (EOR ≥95%) or subtotal resection (EOR <95%). Statistical analysis involved descriptive statistics and inferential tests for outcome comparisons. Results: Patients were aged an average of 42.3 ± 14 years and distributed between 72.5% of males and 27.5% of females. The most common presentation was seizures (65%). The tumor was located in the frontal lobe at 65%, the motor at 75%, and the top tumor pathology was oligodendroglioma (42.5%). The recurrence rate in the study was 20% (8 of 40), and the 1-year survival rate was 92.5%. After the resection, significant improvement was shown in Karnofsky's performance status (P = 0.007), in normal daily activities (P = 0.001), in fine motor skills (P = 0.020), and work hobbies (P = 0.046). No statistically significant improvement was shown in seizures and deficit rates. Recurrence was not associated with the demographic characteristics, clinical presentation, tumor-related characteristics (location, area, side, and mutation), tumor resection, and adjuvant treatment (P > 0.05). Conclusion: GTR of Rolandic gliomas can be achieved with the use of meticulous stimulation mapping, and complete functional recovery is attainable despite common belief.

Complex Presentation of Multicentric Castleman Disease with Coexisting HIV, HHV-8, and Other Opportunistic Infections.

Castleman disease (CD) is a rare lymphoproliferative disorder characterized by benign lymph node enlargement. We present the case of a 43-year-old male with a complex medical history, including Crohn's disease treated with Adalimumab and later complicated with tuberculosis (TB) infection. Subsequently, in May 2021, he was diagnosed with human immunodeficiency virus (HIV) and started on antiretroviral therapy (efavirez, emricitabine, and tenofovir). Despite stropping adalimumab, anti-Tb, and antiviral therapy, he experienced persistent fever, neurological symptoms, and lymphadenopathy. Toxoplasmosis, Cytomegalovirus (CMV), and Human Herpesvirus-8 (HHV-8) were diagnosed and then treated. Furthermore, the patient displayed intermittent febrile episodes, pancytopenia, altered coagulation parameters, hypoalbuminemia, edema, and generalized abdominal pain, as well as radiological evidence of hepatosplenomegaly and pulmonary infiltrates. Left axillary lymph node biopsy (ALNB) was done and confirmed multicentric castleman disease (MCD). Moreover, the bone marrow aspirate showed plasmocytes. His treatment included chemotherapy with doxorubicin and rituximab while continuing his anti-Tb and antiretroviral therapy. This complex case highlights the diagnostic challenges of managing CD in the presence of multiple coexisting conditions, emphasizing the need for comprehensive evaluation in complex clinical presentations.

Montelukast use in pregnancy: A systematic review and meta-analysis of maternal and fetal outcomes in asthma treatment.

This systematic review and meta-analysis evaluated the safety of montelukast in treating asthma during pregnancy, focusing on maternal and fetal outcomes such as congenital anomalies (CA), preterm delivery, low birthweight, spontaneous abortion, gestational diabetes mellitus, and preeclampsia. A comprehensive literature search was conducted in Google Scholar, PubMed, and the Cochrane Library databases from inception until April 30, 2024. The eligible studies assessed the safety of montelukast for asthma treatment during pregnancy. The review suggests that montelukast use during pregnancy may not significantly increase the risk of major CA. The pooled results yielded risk ratio (RR) for CA was 1.13 [95% CI (0.74, 1.73), p = 0.56, I2 = 0%]. Montelukast may be associated with preterm delivery and a low birthweight odds ratio (OR) of 1.82 [95% CI (1.35, 2.45), p < 0.001, I2 = 0%]. No significant risks were found concerning neurodevelopmental outcomes. The associations with spontaneous abortion were inconclusive [OR = 1.03, 95% CI (0.72, 1.5), p = 0.86, I2 = 73%], highlighting the need for further research. This comprehensive review underscores the importance of further investigating the safety profile of montelukast during pregnancy. While the overall findings indicate a relatively favorable safety profile, especially regarding major CA, careful consideration is needed for the potential risks of preterm delivery and low birthweight.

Application of tele-neuropsychology and tele-mental health before and during COVID-19 era: a bibliometric analysis.

Background: Telehealth use was previously limited by strict regulations and financial constraints. However, the pandemic prompted some countries to ease their telehealth laws. Thus, we conducted a bibliometric analysis and network visualization to gauge changes in tele-neuropsychology (Tele-NP) and tele-mental Health (Tele-MH) trends with the onset of the COVID-19 pandemic. Materials and methods: The authors conducted a literature search on SCOPUS and included relevant articles pertaining to Tele-NP and Tele-MH, which were published before the COVID-19 pandemic (2017-2019) and during the COVID-19 pandemic (2020-2022). The authors presented publication patterns on psychiatric disorders, mode of administration, journals, active countries, authors, affiliations, funding sponsors, keywords, publication, and citation output. Results: Three hundred forty-one articles were included in our study with 80 articles before the pandemic and 261 during the pandemic. Our analysis revealed the greatest increase in publications and citations output was from the year 2020 to 2021. A greater number of journals published tele-NP and tele-MH-related research, with higher frequency, during the COVID-19 pandemic with Telemedicine and E-health leading the way. WHO regional analysis revealed that the Region of the Americas (AMRO) was the leading contributor in terms of publications. Harvard Medical Center remained the number one contributor both before and during the COVID-19- pandemic. Publications by funding sponsors, particularly by those that were US-based, increased twice as much during the pandemic. Conclusion: The increase in research output following the COVID-19 outbreak reflects the growing interest and relevance of telemedicine for the delivery of mental health services.

Hydroxychloroquine and the associated risk of arrhythmias.

Hydroxychloroquine (HCQ), which was initially used as an antimalarial drug, is now being used to treat other illnesses, especially rheumatic autoimmune disorders  such as systemic lupus erythematosus, primary Sjögren's syndrome, and rheumatoid arthritis, because it is safe, effective, and cost efficient. This drug has shown high efficacy and has become the first-line treatment for many of these diseases. Although HCQ has many therapeutic effects, it has unfortunately shown some complications, especially with its long-term use. One of these side effects is arrhythmia through prolongation of the QT interval. This narrative literature review focuses on the effects of HCQ on the QT interval in patients with rheumatologic diseases who have been prescribed this drug. In particular, we will focus on the increased risk of arrhythmia when HCQ is administered with other drugs, such as azithromycin and many others, along with drug-drug interactions. In addition, we investigated the safety of this drug in pregnant women.

Association of white blood cell parameters with metabolic syndrome: A systematic review and meta-analysis of 168,000 patients.

BACKGROUND: Leukocyte parameters are predicted to be affected in patients with metabolic syndrome (MetS). We conducted a systematic review and meta-analysis to study the association between white blood cell parameters (WBC) in people with and without MetS. METHODS: PubMed, EMBASE, Scopus and Cochrane Library databases were searched according to the study protocol. The standardized mean difference (SMD) and 95% confidence intervals (CI) of leukocyte markers between individuals with and without MetS were pooled using an inverse variance model. Additionally, a subgroup analysis by sex was performed where possible. Methodological quality assessment was conducted using the Newcastle-Ottawa scale (NOS) for observational studies and the Cochrane Risk of Bias tool 2.0 for Randomized Controlled Trials (RCTs). RESULTS: Of 6068 articles identified, 63 were eligible for the study. Compared to controls, individuals with MetS showed significantly higher concentrations of total leukocyte count (SMD [95% CI]: 0.60 [0.55-0.65]; P < .00001; I2 = 100%), neutrophil counts (0.32 [0.28-0.37]; P < .00001; I2 = 99%), lymphocyte counts (0.15 [0.07-0.23]; P = .0004; I2 = 100%), basophil counts (0.01 [0.00-0.02]; P = .02; I2 = 98%), monocyte counts (0.05 [0.02-0.09]; P = .003; I2 = 99%), and neutrophil-to-lymphocyte ratio (0.24 [0.15-0.33]; P < .00001; I2 = 98%). There were no significant differences in the eosinophil count (0.02 [-0.01 to 0.05]; P = .19; I2 = 96%) and monocyte-to-lymphocyte ratio (0.06 [-0.05 to 0.17]; P = .27; I2 = 100%) between patients with and without MetS, however, the lymphocyte-to-monocyte ratio (0.52 [-0.81 to -0.23]; P = .0005; I2 = 52%) tended to be significantly lower in patients with MetS. CONCLUSION: Biomarkers such as total leukocyte count, neutrophil count, lymphocyte count, basophil count, monocyte count and neutrophil-to-lymphocyte ratio are associated with higher levels in patients in MetS and thus can potentially be used for early detection of MetS.

Role of Glucagon-Like Peptide-1 Receptor Agonists on the Weight Loss of Individuals With Type 2 Diabetes: A Systematic Review.

Obesity is highly associated with type 2 diabetes mellitus (T2DM), both of which can be simultaneously treated with glucagon-like peptide-1 receptor agonists (GLP-1RAs). There are many antidiabetic drugs that can be used for the treatment of T2DM. These drugs have vast modes of action and therapeutic uses. However, they also have different side effects. Some of these side effects, such as weight changes, are sometimes desirable while others are not. This review examines the literature on how GLP-1RA affects both blood glucose and body weight in patients with T2DM and obesity. In this context, GLP-1RA plays a critical part by controlling not only the blood glucose level but also weight. We followed Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and searched for articles from PubMed and Google Scholar databases that reported on T2DM, obesity, and GLP-1RA functions. We selected 13 articles that showed the benefits of GLP-1RA in managing both T2DM and obesity. Our review suggests that GLP-1RA is an innovative therapy that can address both conditions simultaneously.

A Systematic Review of How To Reduce Morbidity in HIV Patients With Cardiovascular Diseases.

The human immunodeficiency virus (HIV) is known to cause cardiovascular diseases in patients infected with HIV. The pathology ranges from atherosclerosis to cardiomyopathy. There are several factors that could possibly cause cardiovascular diseases in the HIV population, including malnutrition and vitamin deficiency (for example, thiamine, B12, and zinc deficiencies); a lifestyle including increased prevalence of alcoholism and illicit drug usage; viral infection; and medication combinations that could cause sudden cardiac deaths. Cardiovascular diseases contribute to major morbidity in these populations and could have a reflection on the global financial burden, thus emphasizing the importance of prevention strategies. In this article, we focused on several factors that contribute to coronary artery disease and other cardiovascular diseases. We found that HIV has direct and indirect effects on the development of coronary artery diseases; furthermore, antiretroviral therapy adds to the deleterious effects of HIV and increases the risk of cardiovascular diseases. We further assessed the causal relationships and associations to understand the research gaps. In conclusion, this paper acknowledges and summarizes the current management strategies and the need to develop future strategies focusing on the prevention of cardiovascular diseases and tailoring the regimens according to the patient's clinical and socio-economic background.

The Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Improving Morbidity and Mortality of Heart Failure: A Systematic Review.

Cardiovascular disease (CVD) is the leading cause of mortality in patients with type 2 diabetes mellitus (DM) worldwide. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) were initially developed for treating patients with type 2 DM. The four major drugs developed are canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. Apart from treating DM, these drugs have shown to have a beneficial effect on lowering cardiovascular death and lowering hospital admission, and have beneficial renal outcomes. Recently, several large-scale randomized controlled trials (RCTs) were done to assess the benefit of these drugs, mainly in patients with CVD, irrespective of their diabetic status. This systematic review examined seven large-scale randomized controlled trials that focused mainly on CVD in patients with type 2 DM and if it showed any improvement. We properly screened the RCTs if they demonstrated cardiovascular outcomes after taking the SGLT2i or a placebo drug. The seven studies combined had a total sample population of 55,433, and the mean follow-up time was about four years. The participants included in this study had various basal metabolic indices, ages, glomerular filtration rates, and diabetic status characteristics. Although these patients were quite different, after the administration of SGLT2i, the studies showed a beneficial effect in reducing CVD mortality and morbidity in patients with type 2 DM.

A Review on Major Pathways Leading to Peritoneal Fibrosis in Patients Receiving Continuous Peritoneal Dialysis.

Peritoneal fibrosis (PF) is the most important complication of peritoneal dialysis (PD) that may arise among patients receiving continuous ambulatory peritoneal dialysis (CAPD). PF is a complex process, and many factors contribute to the formation of fibrosis. PD solutions with high glucose content, chronic inflammation, inflammatory cytokines, angiogenesis, and mesothelial to mesenchymal transition (MMT) are factors contributing to the fibrosis of the peritoneum. These factors, as well as stress-induced fibrosis, are going to be discussed further in this article. Although most experimental models are promising in preventing or delaying PD-related fibrosis, most of these recommended treatment options require further research. The lack of sufficient data from real PD patients and many inconclusive data make clinicians depend on conservative treatment. New therapeutics are indeed required for the management of patients undergoing PD to prevent the dreaded complication that may arise from continuous PD. Newer PD solutions are needed to improve survival and minimize the complication associated with PD. Recently, newer PD solutions have been shown to improve patient survival and peritoneal viability and reduce this complication that may arise as a result of continuous PD.

Increased Risk of Cardiovascular Diseases in Rheumatoid Arthritis: A Systematic Review.

Rheumatoid arthritis (RA) is an autoimmune condition in which the body's joints are attacked by the immune system, leaving the patient disabled in severe cases, with irreversible joint damage and a lower quality of life. RA patients are more likely to develop cardiovascular (CV) disease, which increases their risk of morbidity and mortality. This study systematically reviews various CV diseases that might occur with RA including heart failure (HF), coronary artery disease, acute coronary syndrome, ischemic heart disease, stroke, cardiac death, venous thromboembolism, and valvular diseases. The relation between these complications and RA is specifically assessed. Systematic search was carried out on literature reporting the risk of each of the CV diseases in RA patients from databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases searched were MEDLINE (through PubMed) and Google Scholar using a combination of keywords and medical subject headings (MeSH). Our keywords were mainly "cardiovascular diseases" and "arthritis and rheumatoid". We found a total of 33 articles reporting each CV comorbidity. Interestingly, a wide spectrum of CV diseases is reported in patients with RA. Many tools were implemented in the diagnosis of each disease such as carotid intima-media thickness for atherosclerosis and echocardiography for HF. We confirmed that RA is associated with an increased risk of different CV events, and prophylactic measures should be implemented.

Role of Ultrastructural Study in the Diagnosis of Medical Renal Diseases: A Tertiary Medical Center Experience and Review of the Literature.

The 20th century unfolded many mysteries regarding renal pathology with the advent of ancillary techniques such as immunofluorescence (IF) and electron microscopy (EM) studies. EM plays a major role in confirming the routine and IF findings or may uncover new and unsuspected features. The aim of the study is to elucidate the role of ultrastructural findings in patients with medical kidney diseases on whom kidney biopsy was performed at the American University of Beirut Medical Center, between November 2018 and June 2019. A total of 188 renal biopsies were examined during the study period. EM confirmed the light microscopy diagnosis in 54% of the cases while completely changed the diagnosis in 23% of the cases. In 23% of the sample, EM provided additional features and a secondary diagnosis. Our study emphasizes the important diagnostic role of EM and its significance, particularly in minimal change disease, basement membrane abnormalities, and glomerulopathies.

The Anti-Depressant Effects of Statins in Patients With Major Depression Post-Myocardial Infarction: An Updated Review 2022.

Statins are the most commonly prescribed lipid-lowering agents in patients with cardiovascular disease, and more than half of the patients with cardiovascular disease have associated depressive symptoms, particularly post-myocardial infarction, which is a major trigger for depression. In our research, we tried to understand the anti-depressant effects of statins, the mechanisms, risks and benefits, and potential drug-drug interactions with anti-depressant medications. We reviewed all the relevant information from inception up to September 2022 regarding the anti-depressant effects of statins. The database used was PubMed, and the keywords were statins, major depression, post-myocardial infarction, and hydroxy methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors. We have screened each of the articles carefully, including both human and animal studies, and found a positive correlation between reduction in depressive symptoms with statin therapy as adjunctive treatment with conventional anti-depressants. In conclusion, statins as a monotherapy are not an effective treatment for depression post-myocardial infarction but are good add-on options along with standard therapy such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Statins are safe and have no serious drug-drug interactions with anti-depressants. We would like to encourage large-scale observational studies and further post-marketing surveillance to improve our knowledge regarding the effectiveness of statins in the treatment of depression.

The Usefulness of Combining Noninvasive Methods for Early Identification and Potential Prevention of Cystic Fibrosis-Associated Liver Disease.

Cystic fibrosis-associated liver disease is the third leading cause of morbidity and mortality in patients with cystic fibrosis (CF). Liver damage in the course of CF ranges from biochemical abnormalities to full-blown cirrhosis and may involve complicated processes like inflammation, fibrogenesis, remodeling, apoptosis, and cholestasis. Despite robust research in the field of CF, its complex pathogenesis is not fully understood. Because of the unknown pathogenesis, it is difficult to develop a highly sensitive and specific test or technology that is standardized, acceptable, and available at most pediatric institutions. The Cystic Fibrosis Foundation (CFF) recommends annual blood tests to screen for liver pathology, which often fails to identify early-onset liver disease. In this review article, we present the use of different liver indices and imaging modalities that can help identify liver disease at the onset and may help in its prevention. Although the disease is commonly diagnosed in the pediatric population, due to increased life expectancy, there is increasing evidence of liver disease in adults too. We believe that the tools we present in this review will help in the prevention of liver disease and thereby reduce the associated morbidity and mortality.

Safety and Efficacy of Mesenchymal Stem Cells for the Treatment of Evolving and Established Bronchopulmonary Dysplasia: A Systematic Literature Review.

Bronchopulmonary dysplasia (BPD) is a frequent sequela of modern medicine when infants are born prematurely. Currently, there is no single treatment or combination of treatments to prevent or fully treat BPD. Mesenchymal stem cells (MSCs) have promising properties that could aid in the reversal of lung injury, as seen in patients with BPD. This study reviews the available evidence regarding the safety and efficacy of the use of MSCs for the treatment of evolving and established BPD. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We found eight studies that fulfilled the inclusion and exclusion criteria. While all studies proved the safety and efficacy of MSCs administered intravenously and intratracheally, the only available randomized controlled trial (RCT) failed to demonstrate the benefit of MSC administration in the early treatment of BPD. The remaining studies varied between phase I clinical trials and case reports, but all seemed to show some evidence that MSCs may be of benefit in the late treatment of established BPD. Considering some of the studies have less evidence, early treatment to prevent lung fibrosis may be more successful, particularly in the younger gestational ages where lung development is more immature, and research should focus on this.