BackgroundAcute ischaemic heart disease (AIHD) and atherothrombotic stroke are amongst the leading causes of mortality and disability worldwide, sharing pathogenic mechanisms. Quality indicators (QIs) are essential tools for evaluating and optimizing clinical management. The aim of this article is to develop an integrated organizational model for the care of AIHD and atherothrombotic stroke, incorporating validated and measurable QIs to improve patient outcomes and care coordination.MethodsA multidisciplinary panel of cardiologists, neurologists, internists, primary care physicians and nursing staff reached a consensus through structured meetings. After reviewing the literature and scientific recommendations, the most relevant QIs were selected. When clear standards were lacking, the panel established criteria by consensus. The selected QIs were integrated into a care pathway covering the pre-hospital phase through long-term follow-up.ResultsSixteen key QIs were identified for each process, covering intervention times, secondary prevention, patient satisfaction, rehabilitation, follow-up and clinical outcomes. The model highlights the importance of rapid diagnosis, timely interventions and coordinated discharge planning. Early initiation of intensive lipid-lowering therapy and systematic monitoring of targets such as LDL-c and mortality are emphasized.ConclusionThe proposed QIs and organizational model can be valuable tools for optimizing care and coordination for patients with AIHD and atherothrombotic stroke. They enable the monitoring and improvement of critical aspects of the care process.

BackgroundOxidative modifications of low-density lipoproteins (LDL) have been reported in patients with β-thalassaemia/haemoglobin E (HbE) and are related to cardiovascular complications. Deferiprone (L1) is an iron chelator that decreases iron overload and, consequently, reduces oxidative stress. This study assesses the protective effect of L1 on the oxidative status of LDL in patients with β-thalassaemia/HbE.MethodsTwenty-nine patients with β-thalassaemia/HbE treated with L1 were recruited. The study included a 4-week washout period followed by 4 and 12 weeks of L1 treatment. Non-transferrin-bound iron (NTBI) levels and oxidative stress markers, including thiobarbituric acid reactive substances and α-tocopherol, were monitored at each visit. The rate and content of lipid radical formation following Cu2+-induced LDL oxidation in vitro were detected by NBD-Pen, a specific fluorescence probe.ResultsL1 was shown to prevent the depletion of α-tocopherol, decrease thiobarbituric acid reactive substances and preserve the levels of lipid components in LDL. A negative correlation between serum NTBI and LDL α-tocopherol indicated that the circulating non-redox-active NTBI can lead to the depletion of α-tocopherol. LDL from the washout period showed the highest oxidative susceptibility when evaluated by NBD-Pen.ConclusionIron chelation therapy with L1 improves the oxidative status of LDL in patients with β-thalassaemia/HbE.

BackgroundVirtually all patients with extensive-stage small cell lung cancer (SCLC) develop resistance to first-line platinum-based chemoimmunotherapy and experience relapse. Second-line therapy is therefore an integral part of the treatment paradigm.MethodsEvidence was reviewed for key second-line regimens recommended in major guidelines for treatment of patients with platinum-sensitive relapse (chemotherapy-free interval ≥90 days), focusing on recent prospective clinical trials and post hoc analyses. Case studies of second-line lurbinectedin are presented as examples of the current management approach to platinum-sensitive relapsed SCLC.ResultsSubject to the limitations of cross-trial comparisons, the evidence review allowed us to draw broad conclusions about the place in therapy of approved options for platinum-sensitive relapse. Platinum rechallenge is more effective and better tolerated than topotecan and is a reasonable second-line choice in suitable patients. Topotecan provides modest clinical benefit and has the potential to cause dose-limiting haematological toxicities. Cyclophosphamide-doxorubicin-vincristine combination therapy offers no clear advantages over topotecan. Efficacy outcomes with second-line lurbinectedin are similar or better than those reported with platinum rechallenge, and lurbinectedin has a more favourable safety profile and simpler administration schedule. Second-line lurbinectedin preserves platinum rechallenge for later use and may resensitize tumour cells to platinum with potential survival advantages. Lurbinectedin safety is not affected by advanced age (≥65 years). Case studies highlight objective and durable responses to second-line lurbinectedin, along with good tolerability and quality of life.ConclusionsAvailable evidence supports second-line lurbinectedin as a useful alternative to platinum rechallenge, topotecan and cyclophosphamide-doxorubicin-vincristine in patients with platinum-sensitive relapsed SCLC.

BackgroundAcne vulgaris is one of the most common dermatological illnesses affecting people worldwide. In Pakistan, approximately 9.4% of the population and between 5% and 16% of young adults are affected by acne vulgaris. Conventional therapies (topical benzoyl peroxide, retinoids, antibiotics and oral isotretinoin) are effective but limited by antibiotic resistance and side effects. Curcumin (a natural anti-inflammatory/antimicrobial from turmeric) and serratiopeptidase (a proteolytic enzyme with anti-inflammatory, anti-oedematous and antibiofilm properties) each show promise in acne treatment. This article evaluates the efficacy of a combined oral curcumin plus serratiopeptidase formulation as an adjunct to inflammatory acne therapy.MethodsFifty individuals with mild-to-moderate symptoms of inflammatory acne participated in this quasi-experimental study. They were allocated to standard therapy alone (topical regimen: benzoyl peroxide 5% and adapalene 0.1% gel; oral doxycycline 100 mg once daily) or standard therapy plus a daily curcumin (500 mg) + serratiopeptidase (10 mg) supplement (adjunctive therapy). Acne severity was assessed using a visual analogue scale (VAS) and lesion improvement scale at baseline, 1 week and 2 weeks of treatment. Data were analysed with parametric tests after normalization (log transformation), with significance set at p<0.05.ResultsBaseline characteristics were similar between groups (mean age: 23 years; 66% female). Both groups showed significant improvement in mean VAS (from 7.5 at baseline to 3.1 at 2 weeks; p<0.001). The adjunctive therapy group achieved a markedly higher complete/near-complete improvement rate by week 2 (84% versus 28%; p<0.001). No serious adverse events occurred.ConclusionCurcumin plus serratiopeptidase, as an adjunct to standard therapy significantly, accelerated the resolution of inflammatory acne lesions within 2 weeks, with excellent tolerability. This novel combination targets inflammatory pathways and could reduce reliance on prolonged antibiotics. Larger, longer-term studies are recommended to confirm these findings and evaluate effects on relapse and scarring.

Immunotherapy has revolutionized the treatment landscape for solid tumours. Here, we describe the case of a 69-year-old woman with advanced endometrial cancer (EC) who achieved prolonged disease control with immunotherapy. The patient was diagnosed with stage IIIC EC in February 2020 and was treated with carboplatin and paclitaxel, followed by radiotherapy. Relapses occurred in February 2021 (treated with doxorubicin and palliative radiotherapy) and July 2022 (treated with a carboplatin rechallenge). Pembrolizumab and lenvatinib were started in November 2022. Although the initial scan showed progressive disease, restaging 2 months later showed stable disease, which was maintained on pembrolizumab and lenvatinib until progression in October 2024. This article is part of the New treatment options for advanced endometrial carcinoma Special Issue: https://www.drugsincontext.com/special_issues/new-treatment-options-for-advanced-endometrial-carcinoma.

Carvedilol has shown greater potency than propranolol as a β-blocker in managing cardiac conditions. However, its efficacy in reducing portal hypertension (PHTN) in patients with cirrhosis remains unclear. This study evaluates the efficacy and safety of carvedilol compared with propranolol in managing PHTN. A systematic review and meta-analysis were conducted using PubMed, Scopus and Embase databases. Randomized controlled trials comparing carvedilol and propranolol were included. Primary outcomes were changes in hepatic venous pressure gradient, wedge hepatic venous pressure and free hepatic venous pressure. Secondary outcomes included heart rate, cardiac output and mean arterial pressure. Tertiary outcomes assessed adverse event incidences. Six randomized controlled trials involving 336 patients (171 carvedilol, 165 propranolol) were analysed. Carvedilol significantly reduced hepatic venous pressure gradient (mean difference (MD): 2.22 (95% CI 1.82-2.62); p<0.00001) and wedge hepatic venous pressure (MD: 2.38 (95% CI 1.92-2.84); p<0.00001). Propranolol significantly reduced cardiac output (MD: -0.60 (95% CI -0.74 to -0.45); p<0.00001). Mean arterial pressure was significantly lower in the carvedilol group (MD: 1.79 (95% CI 0.38-3.20); p=0.01). Adverse events, such as orthostatic hypotension and increased diuretic use, were more frequent in the carvedilol group but were manageable. Carvedilol demonstrates superior efficacy in reducing PHTN compared with propranolol, with a slightly higher but tolerable adverse event profile. It may be considered the first-line treatment for PHTN. Further research is needed to validate long-term benefits and safety.

The analysed data further support and confirm the high safety profile of the HA_ALI fillers for different approaches in aesthetic medicine. This evaluation also highlights the importance of post-marketing analysis by continuing to foster a robust understanding of products currently used in daily clinical practice.

Psychomotor agitation (PMA) is a prominent clinical issue frequently observed in various psychiatric and neurological conditions, including schizophrenia, bipolar disorder, Parkinson disease, dementia and substance use disorder. Characterized by motor restlessness, anxiety and irritability, PMA can rapidly escalate into aggression and violence, necessitating prompt intervention to ensure patient and caregiver safety. The prevalence of PMA in psychiatric emergency settings ranges from 4.3% to 10%, imposing a substantial burden on healthcare systems. Despite the critical nature of PMA, there is a lack of standardized treatment protocols, particularly concerning the use of liquid formulations of antipsychotics such as liquid promazine, which may offer unique advantages in emergency care. This review aims to provide a comprehensive analysis of the existing literature on the efficacy, safety and tolerability of liquid antipsychotics, with a particular focus on promazine, in the management of PMA. An extensive literature search was conducted across publicly available databases with no time limitations to ensure the inclusion of all relevant articles. The findings suggest that liquid promazine offers several benefits, including ease of administration, rapid onset of action and improved patient compliance, making it a valuable option in acute PMA management. However, the review also highlights the need for future research, particularly long-term studies and head-to-head comparisons with other antipsychotics, to better establish the clinical utility of liquid promazine. Future research should focus on expanding the evidence base for liquid antipsychotic formulations, which will contribute to improved clinical outcomes in the management of PMA.

Topical chlormethine (CL) gel formulation was approved by the EMA in 2017 for the treatment of adult patients with mycosis fungoides (MF). To expand the knowledge on the management of MF, this paper provides an overview of clinical practice evidence about the MF diagnostic phase and a collection of clinical experiences to better characterize the use of CL gel in daily practice. Collected cases underline the importance of the concomitant biopsy and clinical evaluation in the diagnostic phase, with the contribution of a multidisciplinary team, and support the use of CL gel as a first-line or adjuvant treatment in selected patients.

The discovery of RNA interference in 1998 opened avenues for the manipulation of gene expression, leading to the development of small interfering RNA (siRNA) drugs. Patisiran, the first FDA-approved siRNA medication, targets hereditary transthyretin amyloidosis with polyneuropathy. Givosiran, lumasiran and nedosiran further expand siRNA applications in treating rare genetic diseases, demonstrating positive outcomes. In cardiology, inclisiran, approved for hypercholesterolaemia, showcases sustained reductions in LDL cholesterol levels. However, ongoing research aims to establish its impact on cardiovascular outcomes. Lipoprotein(a), an independent risk factor for atherosclerotic cardiovascular disease, has become a focus of siRNA therapies, precipitating the development of specific siRNA drugs like olpasiran, zerlasiran and lepodisiran, with promising reductions in lipoprotein(a) levels. Research to assess the effectiveness of these medications in reducing events is currently under way. Zodasiran and plozasiran address potential risk factors for cardiovascular diseases, targeting triglyceride-rich lipoproteins. Zilebesiran, which targets hepatic angiotensinogen mRNA, has demonstrated a dose-related reduction in serum angiotensinogen levels, thereby lowering blood pressure in patients with systemic arterial hypertension. The evolving siRNA methodology presents a promising future in cardiology, with ongoing studies assessing its effectiveness in various conditions. In the future, larger studies will provide insights into improvements in cardiovascular outcomes, long-term safety and broader applications in the general population. This review highlights the historical timeline of the development of siRNA-based drugs, their clinical indications, potential side-effects and future perspectives.