Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Novel drug delivery systems for inflammatory bowel disease

Inflammatory bowel disease(IBD)is a chronic illness characterized by relapsing inflammation of the intestines.The disorder is stratified according to the severity and is marked by its two main phenotypical representations:Ulcerative colitis and Crohn’s disease.Pathogenesis of the disease is ambiguous and is expected to have interactivity between genetic disposition,environmental factors such as bacterial agents,and dysregulated immune response.Treatment for IBD aims to reduce symptom extent and severity and halt disease progression.The mainstay drugs have been 5-aminosalicylates(5-ASAs),corticosteroids,and immunosuppressive agents.Parenteral,oral and rectal routes are the conventional methods of drug delivery,and among all,oral administration is most widely adopted.However,problems of systematic drug reactions and low specificity in delivering drugs to the inflamed sites have emerged with these regular routes of delivery.Novel drug delivery systems have been introduced to overcome several therapeutic obstacles and for localized drug delivery to target tissues.Enteric-coated microneedle pills,various nano-drug delivery techniques,prodrug systems,lipid-based vesicular systems,hybrid drug delivery systems,and biologic drug delivery systems constitute some of these novel methods.Microneedles are painless,they dislodge their content at the affected site,and their release can be prolonged.Recombinant bacteria such as genetically engineered Lactococcus Lactis and eukaryotic cells,including GM immune cells and red blood cells as nanoparticle carriers,can be plausible delivery methods when evaluating biologic systems.Nano-particle drug delivery systems consisting of various techniques are also employed as nanoparticles can penetrate through inflamed regions and adhere to the thick mucus of the diseased site.Prodrug systems such as 5-ASAs formulations or their derivatives are effective in reducing colonic damage.Liposomes can be modified with both hydrophilic and lipophilic particles and act as lipid-based vesicular systems,while hybrid drug delivery systems containing an internal nanoparticle section for loading drugs are potential routes too.Leukosomes are also considered as possible carrier systems,and results from mouse models have revealed that they control anti-and pro-inflammatory molecules.

Apheresis:A cell-based therapeutic tool for the inflammatory bowel disease

Inflammatory Bowel Disease(IBD)is a hallmark of leukocyte infiltration,followed by the release of cytokines and interleukins.Disease progression to Ulcerative Colitis(UC)or Crohn’s Disease(CD)remained largely incurable.The genetic and environmental factors disrupt enteral bacteria in the gut,which hampers the intestinal repairing capability of damaged mucosa.Commonly practiced pharmacological therapies include 5-aminosalicylic acid with corticosteroids and tumor necrosis factor(TNF)-α.New interventions such as CDP571 and TNF-blocking RDP58 report the loss of patient response.This review discusses the non-pharmacologic selective granulocyte–monocyte-apheresis(GMA)and leukocytapheresis(LCAP)that have been proposed as treatment modalities that reduce mortality.GMA,an extracorporeal vein-to-vein technique,presents a strong safety profile case for its use as a viable therapeutic option compared to GMA's conventional medication safety profile.GMA reported minimal to no side effects in the pediatric population and pregnant women.Numerous studies report the efficacious nature of GMA in UC patients,whereas data on CD patients is insufficient.Its benefits outweigh the risks and are emerging as a favored nonpharmacological treatment option.On the contrary,LCAP uses a general extracorporeal treatment that entraps leukocytes and suppresses cytokine release.It has been deemed more efficacious than conventional drug treatments,the former causing better disease remission,and maintenance.Patients with UC/CD secondary to complications have responded well to the treatment.Side effects of the procedure have remained mild to moderate,and there is little evidence of any severe adverse event occurring in most age groups.LCAP decreases the dependence on steroids and immunosuppressive therapies for IBD.The review will discuss the role of GMA and LCAP.

Emerging role of biosimilars in the clinical care of inflammatory bowel disease patients

The increasing incidence of inflammatory bowel disease(IBD)globally has redirected the healthcare system's focus towards safe and affordable pharmacological interventions.The inception of anti-tumor necrosis factor-α(TNF-α)had resulted in a trend shift from surgical interventions.However,as the patents of approved anti-TNF-αdrugs expire,biological copies of the many approved products are in the pipeline.The most commonly used biosimilar for IBD has been infliximab,followed by Adalimumab biosimilars which have been approved in major countries across the world.Although biosimilars are approved on the basis of similarity of their reference product,the lack of real-world evidence of its safety in ulcerative colitis and Crohn’s disease patients has contributed to physicians’hesitancy.However,biosimilars are expected to reduce treatment costs and provide economic benefits.

Electrical neuromodulation therapy for inflammatory bowel disease

Inflammatory bowel disease(IBD)is an inflammatory disease of the gastrointestinal(GI)tract.It has financial and quality of life impact on patients.Although there has been a significant advancement in treatments,a considerable number of patients do not respond to it or have severe side effects.Therapeutic approaches such as electrical neuromodulation are being investigated to provide alternate options.Although bioelectric neuromodulation technology has evolved significantly in the last decade,sacral nerve stimulation(SNS)for fecal incontinence remains the only neuromodulation protocol commonly utilized use for GI disease.For IBD treatment,several electrical neuromodulation techniques have been studied,such as vagus NS,SNS,and tibial NS.Several animal and clinical experiments were conducted to study the effectiveness,with encouraging results.The precise underlying mechanisms of action for electrical neuromodulation are unclear,but this modality appears to be promising.Randomized control trials are required to investigate the efficacy of intrinsic processes.In this review,we will discuss the electrical modulation therapy for the IBD and the data pertaining to it.