Myocardial bridge (MB) is common in patients with hypertrophic cardiomyopathy (HCM), and can reduce coronary flow leading to myocardial ischemia, fibrosis, and malignant ventricular arrhythmias resulting in sudden cardiac arrest (SCA). However, MB has not been previously reported as an isolated, modifiable cause of recurrent SCA in pediatric HCM. To describe a case of HCM with recurrent SCA found to have left anterior descending (LAD) coronary artery MB, with resolution of recurrent SCA after MB unroofing. A 13-year-old male with HCM had an epicardial implantable cardioverter defibrillator (ICD) placed after his first SCA at age 8. Atenolol was started after his second SCA at age 12. After a third SCA he was transitioned to Nadolol and Mexiletine, and underwent transvenous ICD implantation due to delayed shock secondary to under-sensing on epicardial system. He had two additional episodes of SCA, for which he was started on Amiodarone and transferred to our institution for transplant evaluation in the setting of biventricular systolic dysfunction. During transplant evaluation, exercise stress test suggested the presence of ischemia. Cardiac catheterization revealed a 6 cm proximal LAD MB, with near occlusion during systole (Figure 1). He underwent LAD unroofing and remained asymptomatic at baseline activity level with no further episodes of SCA during the subsequent follow-up. MB can cause significant compression leading to compromised coronary flow and myocardial ischemia distinct from the intrinsic underlying cardiomyopathy in HCM. Modifiable causes should be considered in cases of recurrent SCA, as treatment may alter prognostic implications.

The global burden of hypertension and its severe form, resistant hypertension, affecting up to 20% of 1.4 billion adults worldwide, drives mass consumption of multiple drugs. Consequently, antihypertensive agents from different classes enter aquatic environments, yet simultaneous extraction of such chemically diverse drugs remains challenging. This work developed a green analytical method for the simultaneous determination of three model antihypertensive agents from distinct classes, namely, furosemide, atenolol, and lisinopril, in water samples. The method employed dispersive liquid-liquid microextraction using a thymol-based natural deep eutectic solvent selected for its superior hydrophobicity and tunability across varying analyte polarities and acid-base characteristics. Extraction was optimized via Box-Behnken design, followed by HPLC-UV analysis on a phenyl column with gradient elution (detection at 220 nm). The validated method showed good linearity (furosemide: 2-100 µg L[-1], lisinopril: 5-100 µg L[-1], and atenolol: 0.1-50 µg L[-1]) with LODs of 0.18, 0.66, and 0.031 µg L[-1], respectively. The practical applicability of the developed method was evaluated by analyzing real water samples collected from multiple sites across Egypt. The results revealed detectable concentrations of the target pharmaceuticals in several samples, confirming the presence of these contaminants in Egyptian water systems. Specifically, furosemide was detected at 4.72 µg L[-1], atenolol at 0.43 µg L[-1], and lisinopril at 7.21 µg L[-1] in samples collected from Giza. A comprehensive greenness assessment using the GAPI, AGREE, BAGI, and EVG tools confirmed strong alignment with sustainable chemistry principles. By enabling multi-class extraction of antihypertensive drugs with a low-ecological-footprint NADES-based protocol, this method addresses a critical gap as no prior NADES-based method exists for these three therapeutic classes together, supporting environmental monitoring and clean water objectives.

Drug-induced acute pancreatitis is uncommon and remains difficult to confirm, particularly when the suspected exposure is an herbal or over-the-counter supplement. Black elderberry, derived from Sambucus nigra, is widely marketed for immune support, but published literature linking it to acute pancreatitis is limited. We report a 75-year-old woman with hypertension, hyperlipidemia, and prior cholecystectomy who presented with abrupt severe epigastric pain radiating to the back, diaphoresis, and lipase 3016 U/L. Computed tomography of the abdomen and pelvis on day 0 showed a normal-appearing pancreas without peripancreatic stranding, fluid collection, pancreatic ductal dilation, or biliary dilation. Triglycerides were 105 mg/dL, adjusted calcium was normal, bilirubin remained normal, and she denied alcohol use. Medication reconciliation revealed daily use of black elderberry extract along with chronic losartan, atenolol, niacin, aspirin, and latanoprost. Her course was consistent with mild acute pancreatitis. She improved with supportive care, early advancement of diet, and discontinuation of elderberry. Because occult biliary disease and medication co-exposure could not be definitively excluded, causality was conservatively classified as possible black elderberry-associated acute pancreatitis. This case reviews the importance of explicit supplement reconciliation in apparent idiopathic acute pancreatitis and the need for endoscopic ultrasound or magnetic resonance cholangiopancreatography after recovery in older adults when initial evaluation is unrevealing.

The Eastern oyster Crassostrea virginica is a filter feeder that is exposed to a variety of anthropogenic contaminants including pharmaceuticals in the seawater within its natural habitat. Atenolol, a β-adrenergic antagonists, is frequently detected in the marine environment. However, the impacts of atenolol on marine organisms have been understudied. This study aims to broaden our knowledge of the impact of pharmaceuticals on marine invertebrates by evaluating the impact of the β-adrenergic antagonist atenolol on oysters hemocytes and assessing the use of C. virginica hemocytes as a screening tool. Results indicate atenolol is sub-lethal with no impact on viability. However, apoptosis temporarily increased for hemocytes exposed to 266 µg/L of atenolol. Furthermore, differences in response by agranulocytes and granulocytes were observed, supporting the need to evaluate hemocyte subpopulations along with the whole population. These findings suggest oyster hemocytes may be a useful tool in addressing the gap of knowledge in ecotoxicological impacts of emerging contaminants on marine organisms and can serve as a preliminary assessment of immunotoxicity of these contaminants prior to in-vivo experiments.

Efonidipine Hydrochloride Ethanolate (EHE) and Chlorthalidone (CTD) are co-formulated for the management of hypertension owing to their complementary pharmacological actions. Ensuring accurate impurity profiling in such combination formulations is vital for maintaining drug stability, safety and regulatory compliance. However, conventional analytical techniques often face challenges related to sustainability and robustness. Reverse Phase High-Performance Liquid Chromatography (RP-HPLC) remains a key analytical approach for impurity determination, yet the integration of Quality by Design (QbD) principles into its development is still evolving. The present study focuses on developing a novel, sustainable RP-HPLC method for impurity profiling of EHE and CTD tablets using a QbD approach and green chemistry. Chromatographic separation was achieved on a Zorbax SB C8 column (150 mm × 4.6 mm, 5 µm). Critical method parameters such as mobile phase composition and pH were systematically optimized through QbD to enhance method robustness. A photolytic degradation product of EHE was identified as Efonidipine Related Compound A, and a plausible photolytic degradation pathway was proposed. A photolytic degradation product was identified in the LC-MS and its structure was confirmed through NMR spectroscopy. The developed green method exhibited excellent resolution, precision and reproducibility across multiple batches, allowing for effective separation and quantification of impurities. This green QbD-optimized, environmentally sustainable RP-HPLC method provides a reliable and scalable solution for impurity profiling in complex pharmaceutical formulations, aligning with modern quality control and regulatory expectations.

Prior research has conducted a limited number of studies on the efficacy of atenolol in preventing atrial fibrillation following cardiac surgery (CS). Consequently, a comprehensive evaluation and meta-analysis were undertaken to assess the effectiveness and safety of atenolol in patients undergoing CS for the prevention of postoperative atrial fibrillation (POAF). A meta-analysis of randomized controlled trials was performed. Searches were conducted across multiple databases up to December 1, 2024. The primary focus was the incidence of POAF. Risk ratios (RRs) for treatment effects on dichotomous variables were calculated. The data analysis encompassed 6 randomized controlled trials involving a total of 870 patients. The meta-analysis revealed that atenolol significantly reduces the incidence of POAF in adult patients undergoing CS (RR, 0.55; 95% confidence interval [CI]: 0.32-0.93; P = .03) with moderate heterogeneity (I2 = 57%; P = .10). Atenolol did not demonstrate superiority over sotalol in reducing POAF (RR, 2.39; 95% CI: 1.41-4.04; P = .001) with moderate heterogeneity (I2 = 40%; P = .19). Furthermore, no significant difference was observed between atenolol and the control group (comprising propafenone, metoprolol, nebivolol, and digoxin) in the prevention of POAF (RR, 1.28; 95% CI: 0.76-2.16; P = .35) with moderate heterogeneity (I2 = 43%; P = .15). Recent studies suggest that atenolol could be a safe and effective intervention for the prevention of POAF in adult patients undergoing CS.

Pharmaceutical compounds (PhACs), continuously released into the environment, represent a growing ecotoxicological threat to aquatic ecosystems. While the toxicity of individual pharmaceuticals has been extensively investigated, the effects of complex mixtures, the so-called "cocktail effect", remain poorly understood, particularly for primary producers such as cyanobacteria. This study evaluates the individual and combined effects of four commonly detected pharmaceuticals in aquatic environments: acetaminophen (APAP), atenolol (ATN), carbamazepine (CBZ), and diazepam (DZP), using the model cyanobacterium Microcystis aeruginosa over a 25-day exposure period at environmentally relevant concentrations (0.01-545 µg/L). The results demonstrate a clear dose-dependent toxicity of the individual compounds (biomass reduced by 85-91%; chlorophyll reduced by 54-70%). Exposure to lower concentrations exhibited moderate reductions in chlorophyll (0.23-0.81 mg/L to 4.90-5.96 mg/L). The most remarkable results are the amplification of toxicity at combined low concentration (low-mix group caused 52% growth inhibition compared to only 14-24% of single pharmaceuticals at the same low doses). The high-dose mixture had the greatest effect on M. aeruginosa by 58.7% growth inhibition. Multi-biomarker analyses indicated significant changes in 1) esterase activity (60.7% decrease), 2) microcystin-LC production (fivefold increase from 0.55 to 2.90 µg/L), and 3) genotoxic effects (IF > 1.5), as evidenced by the SOS chromotest particularly in treatments containing CBZ. Overall, the multi-biomarker responses indicate that pharmaceutical mixtures overwhelm cellular defenses, inducing amplified stress responses even at environmentally realistic concentrations. These findings highlight the urgent need to incorporate mixture toxicity into risk assessment frameworks.

Refractory arterial hypertension (HTN) is a newly described severe phenotype of anti-hypertensive therapy failure. It is defined as uncontrolled blood pressure on (near-)maximal treatment using ≥ 5 antihypertensive drugs, two of which are long-acting thiazide-like diuretics (e.g. chlorthalidone) and mineralocorticoid receptor antagonists, with an additional requirement in one of the first reports: uncontrolled blood pressure after a minimum of three visits to the department. We observed important differences in the definitions of refractory HTN over time and even in the same period in the most important documents in medicine today - guidelines. The AIMs of the study were threefold: to underline the high risk and consequent importance of this phenotype of HTN, to analyze the evolution of the definition of refractory HTN and the consonance in the guidelines on the topic, to study potential insufficiencies of the current definitions, and possibly suggest some improvements. Patients with refractory HTN are at a higher risk of developing cardiovascular complications such as heart failure (HF), left ventricular hypertrophy (LVH), or stroke than those with controlled resistant HTN. Moreover, hypertension-mediated organ damage and comorbidities such as diabetes and obstructive sleep apnea are more prevalent in patients with refractory HTN. Some guidelines list treatment for refractory HTN, but the definition of refractory HTN is actually resistant to HTN. Generally, what is recognized as insufficient for the definition of resistant HTN is also likely true for refractory HTN.

Dermatologists play a central role in the diagnosis and medical management of vascular anomalies. Currently, vascular anomalies are categorized into vascular tumors and vascular malformations. The latest designations for the numerous types of vascular lesions are delineated in the International Society for the Study of Vascular Anomalies website (www.issva.org). The arenas for the therapy for hemangiomas, the most common vascular tumor, have been studied extensively and have been recognized as standard of care by the Society for Pediatric Dermatology, the American Academy of Dermatology and the American Academy of Pediatrics. Options for hemangioma treatment include systemic beta-blockers such as propranolol, atenolol, and nadolol, and the topical beta-blocker timolol. Vascular malformations and overgrowth syndromes encompass a separate set of treatment regimens. Recent pharmacological and technological advances in the medical management of vascular anomalies have decreased the need for surgery in many patients while also leading to improved outcomes and quality of life. This review will guide the dermatologist through the current medical treatment landscape for vascular malformations.

This study presents a sustainable chemometric-assisted UV spectrophotometric strategy for the simultaneous determination of candesartan cilexetil (CAN), chlorthalidone (CTL) and amlodipine (AML) in laboratory-prepared mixtures and commercial pharmaceutical formulations. Owing to the extensive spectral overlap of the three drugs in the UV region, conventional spectrophotometric methods are inadequate for their direct simultaneous analysis. To address this challenge, multivariate calibration models based on principal component regression (PCR), partial least squares (PLS) and genetic algorithm-optimized partial least squares (GA-PLS) were developed, enabling accurate quantification without prior separation or complex sample preparation. A design of experiments (DoE) approach was employed to construct the calibration set, while an independent validation set was generated using orthogonal array-based Latin hypercube sampling (OALHS) to ensure robust external validation across the concentration domain. The GA-PLS model enhanced predictive performance through effective wavelength selection, reducing spectral redundancy and improving model robustness. Furthermore, variable importance in projection (VIP) analysis was employed to identify the most influential spectral variables and provide insight into the spectral regions contributing to analyte quantification. The developed models exhibited excellent analytical performance, characterized by low calibration errors (root mean square error of calibration [RMSEC] < 0.30), strong predictive ability and satisfactory external validation results (RMSEP = 0.2278-0.4419; RRMSEP = 0.1558-0.3978), with recoveries ranging from 99.0% to 100.0%. The sustainability of the proposed methodology was assessed using the multi-colour assessment (MA) tool according to white analytical chemistry principles, yielding a high whiteness score and demonstrating superior environmental performance compared with conventional chromatographic methods. In addition, the graphical layout tool for analytical chemistry evaluation (GLANCE) visualization framework provided a comprehensive graphical assessment of analytical performance and sustainability metrics. The proposed chemometric strategy offers a rapid, reliable, cost-effective and environmentally friendly alternative for routine quality control of multicomponent pharmaceutical formulations.

Genetic bone diseases are a rare group of afflictions suffered by the general population. However, their rarity should not diminish research efforts to help patients understand and treat their diseases. This review summarizes the pathology, symptoms, diagnosis, and treatment insight into six well-known genetic bone diseases. Only six bone diseases are included due to the relatively low prevalence of them as whole limiting our scope to ensure accurate information and attention is provided for each disease individually. A literature search of PubMed is conducted, including studies published within the past five years (January 2020-December 2025). Thirty-six studies met inclusion criteria, and no significant risk of bias is identified among the selected articles. Study findings are synthesized into disease overview, clinical and radiographic features, and diagnostic and treatment approaches. Actively developing or novel therapies relevant to each disease are also included. These treatments include: fresolimumab for osteogenesis imperfecta, small interfering ribonucleic acid (RNA) therapy for Osteopetrosis, denosumab for Paget's disease of bone, vosoritide/recifercept/infigratinib for achondroplasia, mesenchymal stem cell therapy for craniosynostosis, and combination losartan and atenolol therapy for Marfan syndrome. These treatments are generally more recently acknowledged in literature and are either actively undergoing research or require further research to determine their efficacy.