Iron Dyshomeostasis and Mitochondrial Function in the Failing Heart: A Review of the Literature

Cardiac contraction and relaxation require a substantial amount of energy provided by the mitochondria. The failing heart is adenosine triphosphate (ATP)- and creatine-depleted. Studies have found iron is involved in almost every aspect of mitochondrial function, and previous studies have shown myocardial iron deficiency in heart failure (HF). Many clinicians advocated intravenous iron repletion for HF patients meeting the conventional criteria for systemic iron deficiency. While clinical trials showed improved quality of life, iron repletion failed to significantly impact survival or significant cardiovascular adverse events. There is evidence that in HF, labile iron is trapped inside the mitochondria causing oxidative stress and lipid peroxidation. There is also compelling preclinical evidence demonstrating the detrimental effects of both iron overload and depletion on cardiomyocyte function. We reviewed the mechanisms governing myocardial and mitochondrial iron content. Mitochondrial dynamics (i.e., fusion, fission, mitophagy) and the role of iron were also investigated. Ferroptosis, as an important regulated cell death mechanism involved in cardiomyocyte loss, was reviewed along with agents used to manipulate it. The membrane stability and iron content of mitochondria can be altered by many agents. Some studies are showing promising improvement in the cardiomyocyte function after iron chelation by deferiprone; however, whether the in vitro and in vivo findings will be reflected on on clinical grounds is still unclear. Finally, we briefly reviewed the clinical trials on intravenous iron repletion. There is a need for more well-simulated animal studies to shed light on the safety and efficacy of chelation agents and pave the road for clinical studies.

Memantine as a Potential Therapy in Subacute Herpetic Neuralgia: A Randomized Clinical Trial

Background: Varicella-Zoster virus (VZV) is the causative agent of herpes zoster, or "shingles." Most cases of acute herpes zoster are self-limiting, although the pain can cause significant suffering, and experience postherpetic neuralgia (PHN), particularly in older adults. Early treatment of herpetic neuralgia in the subacute phase may prevent PHN progression. This study aimed to evaluate the efficacy of memantine in the treatment of subacute neuropathic herpes zoster. Methods: This randomized clinical trial was performed on sixteen patients aged 18-75 years with subacute herpetic neuralgia. Patients were randomly assigned to the intervention or control group according to the inclusion and exclusion criteria (8 in each group). The duration of the study was eight weeks. Patients in the memantine group received Gabapentin 300 mg per day and memantine 5 mg twice a day. Then, after one week, the memantine dose was tapered up to 10 mg twice a day. In the control group, patients received only Gabapentin from the first week to the end of the study. DN4 questionnaire is used to measure the severity of nerve pain. The patients of both control and intervention groups completed the questionnaire before starting the treatment and it was done again after the end of the treatment period (8 weeks). Results: The results showed improvement in pain in patients who received Memantine along with Gabapentin in comparison with Gabapentin alone (P =0.001). Moreover, the DN4 questionnaire score evaluation indicated a significant difference only for the intervention group's Q1 variable in within-group analysis (P =0.031). Conclusion: Co-administration of memantine with Gabapentin reduced the severity of subacute neuropathic herpes. In addition, memantine is expected to be a viable option for treating and relieving subacute and chronic nerve pain in patients.

An Investigation of Insulin Resistance and Cachexia Relation in Patients with Metastatic Gastrointestinal Malignancies

Background: Insulin resistance has been suggested as one of the known metabolic disorders during cachexia. This study hypothesized that cachexia in cancer patients might be related to insulin resistance as early as cachexia development. Methods: This study was performed on 46 patients with metastatic gastrointestinal cancer. Anthropometric characteristics and biochemical markers were assessed at baseline, second and third month. Insulin resistance was assessed using the homeostasis model assessment-estimated insulin resistance (HOMA IR) method. SFQ-36 questions were used to assess the patients' quality of life at baseline, second and third months. Results: Anthropometric characteristic was significantly associated between pre-cachectic and non-pre-cachectic patients in third month. Cholesterol (P-value = 0.93), albumin (P-value: 0.82), and serum creatinine (P-value = 0.88) in pre-cachectic patients decreased over three months. There was an increasing trend of insulin resistance between pre-cachectic and non-pre-cachectic patients in third month. Cholesterol had an upward trend with a significant relation in cachectic patients [(P-value = 0.00), (P-value = 0.03), (P-value = 0.01)]. We detected a decreasing trend of insulin resistance between cachectic and non-cachectic patients from second to third month (P-value = 0.04). SFQ evaluation had no significant relation with cachectic status. Conclusion: Previous studies showed that the use of NSAIDs, progesterone’s, corticosteroids, COX-2 inhibitors, anabolic agents and drugs targeting inflammatory cytokines may be beneficial for improving of symptoms of cachexia. Significant relation between anthropometric variables with pre-cachexia and cachectic conditions was concluded. Patients' outcome and its relation with insulin resistance demonstrated a significant relation between the cachectic and non-cachectic patients in the third month. We also detected the increased serum cholesterol level in cachectic patients, moreover, higher cholesterol levels in expired cachectic patients than in the living.

Drug Utilization Evaluation of Agents Administered for Prevention and Treatment of Cancer-Related Infections

Background: Due to the critical role of antibiotics and increasing trend of resistance in developing countries, comprehensive methods of antibiotic use is necessary to limit the threat of resistant microorganisms. In this study we compare antibiotics consumption by Defined Daily Dose (DDD) per 100 bed-days in Shahid Ghazi hospitals during three months in Tabriz, Iran. Methods: This is a retrospective study, which enrolled patients with malignancy who admitted to Shahid Ghazi hospital from January till March 2016. From all, 58 patients diagnosed with malignancy and received antibiotics for prophylaxis and/or treatment. For the purpose of Drug Utilization Evaluation (DUE) all antibiotics, antifungals and antiviruses consumption for any reason (prophylaxis, empiric therapy, targeted therapy) were recorded. Data on administered medications such as indication, duration, and dose were compared according to the guidelines of the NCCN 2.2016. The accuracy of antibiotics consumption was assessing by NCCN (2.2016) guideline. Anatomical Therapeutic Chemical (ATC) code J01 was explained as defined daily doses per 100 bed- days (DDD/100) according to the ATC/DDD classification. The amount of consumption was assessed with DDD per 100 bed-days in three months. Results: from 56 patients, 46 of them had hematologic malignancy and 10 of them had solid tumors. The indication of antibiotics and antifungal prophylaxis were wrong in 19.6% of indications. The prophylaxis dosage of antibiotics, antifungal, antiviral and PCP were wrong in 8.8%, 41.7%, 80% and 50%, respectively. The prophylaxis duration of antibiotics, antifungal, antiviral and PCP were wrong in 69.4%, 61.2%, 80% and 100% respectively. The dose adjustment of antibiotics with GFR and renal status of patients, in 8 of 9 patients (88.88%) who received meropenem, and in 9 of 23 patients (39.13%) who received imipenem, were not applicable according standard guidelines. The total consumption of systemic antibiotics in Ghazi Hospital during 3 months was 5091 (Table 7). From all patients 75% of them received antibiotics according to the ATC/DDD classification System. Conclusion: Specific strategies should be employed in infection control development and engage rational antibiotic utilization in order to reduce future resistant strains and increase anti-microbial efficacy.

Non-coding RNAs role in intracranial aneurysm: General principles with focus on inflammation

Intracranial aneurysm (IA) is one of the most challenging vascular lesions in the brain for clinicians. It was reported that 1%-6% of the world's population is affected by IAs. Owing to serious complications arising from these lesions, much attention has been paid to better understand their pathophysiology. Non-coding RNAs including short non-coding RNAs and long non-coding RNAs, have critical roles in modulating physiologic and pathological processes. These RNAs are emerging as new fundamental regulators of gene expression, are related with the progression of IA. Non-coding RNAs act via multiple mechanisms and be involved in vascular development, growth and remodeling. Furthermore, these molecules are involved in the regulation of inflammation, a key process in the formation and rupture of IA. Studying non-coding RNAs can yield a hypothetical mechanism for better understanding IA. The present study aims to focus on the role of these non-coding RNAs in the pathogenesis of IA.