Important Cause Of Premature Death Research Articles

A study of acute stroke syndromes in patients of type 2 diabetes mellitus in a tertiary care hospital in south Rajasthan - A cross sectional observational study

Introduction Stroke is one of the leading causes of death and long term disability in India. Stroke is an important cause of premature death and disability in low- income and middle-income countries like India, largely driven by demographic changes and enhanced by the increasing prevalence of the key modifiable risk factors. Among all the neurological diseases of adult life, cerebrovascular accidents clearly ranks first in frequency of importance. Almost fifty percent of neurological diseases in general hospital are due to stroke. Cerebrovascular accident includes ischemic stroke, hemorrhagic stroke, and cerebrovascular anomalies such as intracranial aneurysm, AV malformation and cortical venous thrombosis. Stroke after heart disease, is the second most common cause of death among noncommunicablediseases.[1] With the introduction of effective treatment for hypertension, there has been a marked reduction in the frequency of stroke.

TO STUDY THE CORRELATION BETWEEN SERUM ALBUMIN LEVEL AND OUTCOME IN PATIENTS ADMITTED WITH ACUTE ISCHEMIC STROKE

Background Stroke is becoming an important cause of premature death and disability in low- income and middle-income countries like India, largely driven by demographic changes and enhanced by the increasing prevalence of the key modiable risk factors. Despite early initiation of treatment protocols, there may be long lasting debilitating sequel. Therefore, there has been a search for neuroprotective agents which might improve the prognosis of stroke. Methods Study was conducted at MGM Medical College and Hospital, Navi-Mumbai where in 75 patients admitted with acute ischemic stroke selected for the study. Proper consent was taken from the patients after checking the inclusion criteria. Their serum albumin levels were checked at the time of admission and discharge and Modied Rankin score was calculated to assess functional status. Results The mean serum albumin levels at the time of admission was 3.86 ± 0.49 g/dL and the mean serum albumin levels at discharge were 3.95 ± 0.47 g/dL. Approximately 73.32% of the cases had MRS score up to 3 had serum albumin levels of 4.0 to 4.49 g/dL and 27% had MRS score more than 3 had albumin level 3 – 3.99 g/dL. Conclusion It is concluded that low serum albumin levels are associated with poor functional outcomes as reected by an increase in MRS score. Thus, in general, low serum albumin levels are associated with worse functional outcomes.

Targeted Treatment against Lipoprotein (a): The Coming Breakthrough in Lipid Lowering Therapy.

Atherosclerotic cardiovascular diseases (ASCVD) are a very important cause of premature death. The most important risk factor for ASCVD is lipid disorders. The incidence of lipid disorders and ASCVD is constantly increasing, which means that new methods of prevention and treatment of these diseases are still being searched for. In the management of patients with lipid disorders, the primary goal of therapy is to lower the serum LDL-C concentration. Despite the available effective lipid-lowering therapies, the risk of ASCVD is still increased in some patients. A high level of serum lipoprotein (a) (Lp(a)) is a risk factor for ASCVD independent of serum LDL-C concentration. About 20% of Europeans have elevated serum Lp(a) levels, requiring treatment to reduce serum Lp(a) concentrations in addition to LDL-C. Currently available lipid lowering drugs do not sufficiently reduce serum Lp(a) levels. Hence, drugs based on RNA technology, such as pelacarsen, olpasiran, SLN360 and LY3819469, are undergoing clinical trials. These drugs are very effective in lowering the serum Lp(a) concentration and have a satisfactory safety profile, which means that in the near future they will fill an important gap in the armamentarium of lipid-lowering drugs.

Proportion of Chromosomal Disorders and Their Patterns among Births with Congenital Anomalies in Africa: A Systematic Review and Meta-Analyses.

Worldwide, surveys have shown that the frequency of chromosomal disorders among births with congenital anomalies varies greatly from country to country. It is well known that chromosomal disorders are an important cause of premature death or life-long disability; however, the absence of local epidemiological data on their birth prevalence and outcomes impedes policy and service development in many countries and continents. Therefore, the current systematic review and meta-analysis intend to show the pooled proportion of chromosomal disorders among births with congenital anomalies in Africa. From PubMed, Cochrane Library, and Google Scholar, we systematically reviewed and meta-analyzed the studies that examined the incidence, prevalence, and types of chromosomal disorders using PRISMA guidelines. A weighted inverse variance random-effects model was used to estimate the pooled proportion of chromosomal disorders among births with congenital anomalies. From the total of 3,569 studies identified, 1,442 were from PubMed, 108 were from Cochrane Library, 1,830 were from Google Scholar, and 189 were from other sources. After duplication was removed, a total of 844 articles remained (2725 were removed by duplication). Finally, 144 full-text studies were reviewed and 60 articles with 52,569 births having congenital anomalies met the inclusion criteria and were selected for this meta-analysis. The pooled proportion of chromosomal disorders among births with congenital anomalies was 8.94% (95% CI; 7.02, 10.86; I 2 = 98.8%; p < 0.001). Conclusions and Future Implications. In the current systematic review and meta-analysis, the pooled proportion of chromosomal disorders among births with congenital anomalies in Africa was small. Down syndrome (trisomy 21) accounted for more than 80% of chromosomal disorders. The pooled proportion of chromosome disorders was the highest in North African regions and countries compared to other regions of the continent. Healthcare managers should focus on establishing proper cytogenetic diagnostic facilities in collaboration with well-trained genetic counseling services in the continent.

The cost of suspected and confirmed bacterial meningitis cases treated at Jimma University Medical Center, Ethiopia

Infections of the central nervous system (CNS) such as meningitis or encephalitis can be caused by myriad of microorganisms and may be life-threatening. In Ethiopia, it is an important cause of premature death and disability, being the 9th most common cause of years of life lost and loss of disability-adjusted life years.The objective of this study was to estimate the cost of suspected and confirmed bacterial meningitis among inpatient managed patients at JUMC. A facility-based cross-sectional study was conducted from July 28 to September 12, 2018. A semi-structured questionnaire was used in this study. Checklists were used to collect the types of laboratory tests performed and prescribed medications. This cost of illness study was conducted from the patient perspectives. We employed a micro-costing bottom-up approach to estimate the direct cost of meningitis. The human capital approach was used for estimating wages lost. Among total patients admitted and treated in JUMC, higher proportions (69.8%) were suspected bacterial meningitis but have been treated as confirmed cases. Total median costs for both suspected and confirmed bacterial meningitis patients were estimated to be ETB 98,812.32 (US $ 3,593.2; IQR 1,303.0 to 5,734.0). Total median direct cost was ETB 79,248.02 (US $ 2,881.75; IQR 890.7 to 3,576.7). Moreover, 45.3% of the patients reported that they were either admitted or given medication at JUMC or nearby health facility before their current admissions. These findings indicate that most cases of bacterial meningitis were treated only empirically, and the cost of the treatment was high, especially for resource-limited countries like Ethiopia. To minimize the burden of meningitis and avoid unnecessary hospitalizations, the availability of diagnostic techniques is vitally important.

RISK FACTOR ASSESSMENT IN APHASIA PATIENTS OF FIRST EVER ISCHEMIC STROKE (FEIS)

Stroke is an important cause of premature death and disability in low-income and middle-income countries like India. Approximately 1/3 of stroke patients may develop aphasia. By targeting various risk factors, we can reduce the incidence of stroke and also aphasia. To assess various risk factors in patients of FEIS with Aphasia.Objectives: Method: A prospective cross-sectional study in patients of FEIS with aphasia, were evaluated for well-known risk factors followed by stroke and language assessment using National Institute of Health Stroke Scale (NIHSS) and Modied Western Aphasia Battery (WAB)9. Majority of the patients were between 66-70yr (48.52%) age group and mean age of study population wasResults: 69.07±6.5 years. Patients with uent and non-uent aphasia had mean age of 65.80 years and 71.09 years respectively. Majority of patients were females (54.41%) and Hypertension (55.88%) was the most prevalent risk factor among study group followed by smoking. Hypertension showed signicant correlation with the severity of stroke (p value=0.02). Early detection andConclusion: prompt management of risk factors can help prevent this disabling events like stroke and aphasia.

Effectiveness of educational package on knowledge and practice regarding prevention of Coronary Artery Disease (CAD) among patients with modifiable risk factors of CAD

Cardiovascular diseases are becoming a leading cause of morbidity and mortality in developing countries, where communicable diseases are being brought under control. Among them coronary artery disease has become the most important cause of premature death and disability in the population. Therefore, present study aims to assess the effectiveness of Planned Teaching Program (PTP) on knowledge and practice regarding prevention of coronary artery disease (CAD) among patients with modifiable risk factors of CAD. Pre experimental research design was selected to conduct the study. 120 patients with modifiable risk factors of CAD were selected for this study by using purposive sampling technique. Result revealed that around 75% patients with modifiable risk factors of CAD had inadequate knowledge score and practice score in pre-test. Whereas in post-test approximately 80% patients with modifiable risk factors of CAD had adequate knowledge score and practice score. The Paired‘t’ test value for knowledge level was 33.67 and for practice level it was 29.41, which was greater than table value at .05 level of significance. This shows that there is significant difference between the pre-test and post-test level of knowledge and practice regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD. There was significant positive correlation r = 0.570 found between post-test knowledge score and post-test practice score. There was no significant association found between the pre-test knowledge score and pre-test practice score regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD with demographic variables. Conclusion: Study concluded with strong need for proper health education in enhancing knowledge and practice regarding prevention of coronary artery disease among patients with modifiable risk factors of CAD.

The use and the cost of outpatient diagnostic procedures for cardiovascular diseases in Isfahan province: A utilization study.

BACKGROUND:Cardiovascular diseases (CVDs) are among the most important causes of premature death, disability, disease burden, and increasing the cost of healthcare worldwide. Having an overview of service utilization can help policymakers to plan more effective use of those services and to cut costs. Thus, this study aims to determine the amount of use as well as the cost of various outpatient diagnostic procedures for CVDs in Isfahan province of Iran from 2011 to 2017.MATERIALS AND METHODS:This descriptive study used insurance claim data (time period: 2011–2017) from Health Insurance Organization in Isfahan province to determine the amount of use and the cost of various outpatient diagnostic procedures for CVDs. Afterward, based on these data, the use and the cost of various outpatient diagnostic procedures for CVDs were estimated for the total population of Isfahan province. The list of outpatient diagnostic procedures for CVDs was carefully chosen according to experts' opinions.RESULTS:The use and the cost of outpatient diagnostic procedures for CVDs have drastically increased in the study period (2011–2017). Since 2011, the number of procedures and their related costs have increased 6.6 and 30.76 times (11.74 times, adjusted with PPP conversion factor), respectively. Per capita use (per thousand people) was 18.75 in 2011, reaching 116.51 in 2017. Per capita cost (per thousand people) was 1,887,660 IRR (355 PPP$) in 2011, reaching 54,660,365 IRR (3920 PPP$) in 2017. The highest cost and use were related to echocardiography and electrocardiography, respectively. A notable increase has been observed in the share of radionuclide myocardial perfusion scan and analysis of pacemakers and ICDs of the total cost.CONCLUSIONS:The use of outpatient diagnostic procedures for CVDs has drastically increased during the studied period. Consequently, the cost borne by the health system and the patients have notably increased. This may be because of the increase in the incidence and prevalence of CVDs during the study period. Greater access to related health services can be mentioned as another reason for this increase. Further research is needed to explain all potential reasons and their importance, which can provoke a suitable health policy reaction.

A RANDOMISED CONTROL TRIAL ON CEREBRO VASCULAR ACCIDENT PATIENTS WITH REFERENCE TO AETIOLOGY AND MANAGEMENT: 24 WEEKS, SINGLE-CENTER, PROSPECTIVE OBSERVATIONAL PILOT STUDY

Objectives: Stroke is one of the leading causes of death and long-term disability in world. Stroke is an important cause of premature death and disability in low-income and middle-income countries like India, largely driven by demographic changes and enhanced by the increasing prevalence of key modifiable risk factors. The main aim of our study was to assess the clinical profile with special reference to the etiology of the condition, the management, and drug utilization review.&#x0D; Methods: This is a hospital-based prospective observational randomized control trial which was conducted for a period of 6 months at Government General Hospital, Rajiv Gandhi Institute of Medical Sciences, Kadapa. Seventy-five patients were recruited based on study criteria. The data were analyzed and summarized as frequency and percentage by GraphPad Prism software using Microsoft Excel.&#x0D; Results: In a total of 75 patients, it was found that 45 and 30 patients were female. Maximum number of patients (i.e. 36 patients) belonged to 51–60 years age group. We observed that 52 patients were suffering from ischemic stroke, 21 patients were suffering from transient ischemic stroke, and only 2 patients were suffering from ischemic stroke and transient ischemic stroke. Among 75 patients studied, hypertension (62%), diabetes mellitus (28%), smoking (33%), and alcohol (33%) were the risk factors.&#x0D; Conclusion: In this study, ischemic stroke was most prevalent. Hypertension, that is, increase of blood pressure considered as one of the important and major risk factors for stroke occurrence and recurrence. Proper management includes non-pharmacological (physiotherapy) along with pharmacological treatment that included cardiovascular system drugs such as hypolipidemics, cognition enhancers, anticoagulants, and antihypertensive therapy.

Role of Plasma Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 and microRNA-98 in Severity and Risk of Coronary Artery Disease.

Coronary artery diseases are the most important cause of premature death, and these diseases are predominantly related to atherosclerosis. Soluble lectin-like oxidized low-density lipoprotein receptor-1 and microRNAs are closely associated with atherosclerotic coronary heart diseases. To investigate the relationship between the severity and risk of coronary artery disease and plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 and miR-98. Case-control study. Angiographically documented patients with 38 single-vessel, 75 double-vessel, and 62 multi-vessel coronary artery disease; 62 healthy control participants; and 24-hour hypoxic (1% oxygen) human umbilical vein endothelial cells were included in this study. Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 concentrations were determined through enzyme-linked immunosorbent assays, and miR-98 expressions were measured by quantitative real-time polymerase chain reaction. The expressions of plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 levels were progressively and significantly higher in patients with single-vessel, double-vessel, and multi-vessel coronary artery disease than in healthy controls (p<0.001). Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 concentrations in female patients with multi-vessel, double-vessel, and single-vessel coronary artery disease had evidently elevated compared with that in male patients (p<0.001). Plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 levels were remarkably increased in females with coronary artery disease in different age groups compared with the males in the same age groups (p<0.001). Patients with single-vessel (areas under the curve=0.879), double-vessel (area under the curve=0.928), and multi-vessel (area under the curve=0.943) coronary artery disease have been clearly differentiated from healthy participants with respect to high sensitivity and specificity. The expression of miR-98 was noticeably downregulated in patients with single-, double- and multi-vessel occluded coronary artery disease and in hypoxic human umbilical vein endothelial cell compared with controls (p<0.001). Significantly elevated lectin-like oxidized low-density lipoprotein receptor-1 and caspase-3 activity and remarkably decreased cellular viability in hypoxic injured human umbilical vein endothelial cell. On the contrary, mimic of miR-98 markedly reduced caspase-3 and lectin-like oxidized low-density lipoprotein receptor-1 levels and highly increased cellular viability. Elevated circulating plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 levels have a potential impact to identify the severity of coronary artery disease and have a strong correlation with aging as well as the female gender. Reduced plasma miR-98 level is possibly considered a risk factor for coronary artery disease, and agomiR-98 prevents atherosclerosis and cellular injury by targeting lectin-like oxidized low-density lipoprotein receptor-1.

Role of Plasma Soluble Lectin Like Oxidized Low-Density Lipoprotein Receptor-1 in Severity of CAD Patients and Relationship with Microrna-98

Coronary artery diseases are the most important cause of premature death and it is predominantly related to atherosclerosis. Soluble lectin like oxidized low-density lipoprotein receptor-1 (sLOX-1) and microRNAs are closely associated with atherosclerotic coronary heart diseases. The current study investigated the relationship of plasma slOX-1and the severity of coronary artery disease patients (CAD) and association with microRNA-98. Case control study. Angiographically documented 38 single coronary lesions, 75 double coronary artery disease, 62 multi-vessel coronary artery disease patients, 62 healthy control subjects, and 24h hypoxic (1% O2) HUVEC cells were included in this study. Circulating sLOX-1concentrations were determined through enzyme-linked immunosorbent assays and microRNA-98 expressions were measured by the quantitative real- time polymerase chain reaction. The expressions of plasma sLOX-1 levels were progressively and significantly higher in single, double, and multi-vessel CAD patients than healthy control subjects (p<0.001). Circulating sLOX-1 concentrations in multi-vessel, double vessel and single vessel CAD female subjects had evidently elevated than male subjects (p<0.001). Plasma sLOX-1 values were remarkably increased in female different age groups CAD patients as compared with the same male age subjects (p<0.001). Single vessel diseased (AUC 0.879), double vessel diseased (AUC 0.928) and multi-vessel diseased (AUC 0.943) CAD patients have been clearly differentiated from healthy participants with high sensitivity and specificity. The expression of microRNA-98 noticeably down-regulated in single, double and multi-vessel occluded CAD patients and hypoxic exposed HUVEC than controls (p<0.001). Significantly elevated LOX-1 and caspase-3 activity and remarkably decreased cellular viability in hypoxic injured HUVEC. On the contrary, mimic of microRNA-98 markedly reduced caspase-3 and LOX-1 levels and highly increased cellular viability. Elevated circulating plasma sLOX-1 levels have a potential impact to identify the severity of coronary artery disease and a strong correlation with aging as well as the female gender. Reduced plasma miR-98 level possible considers a risk factor for CAD, and agomiR-98 prevents atherosclerosis and cellular injury through targeting LOX-1.

Coronary plaque burden in Turner syndrome a coronary computed tomography angiography study.

Turner syndrome (TS) is associated with coronary artery disease (CAD), an important cause of premature death in TS. However, the determinants of CAD in women with TS remain unknown. In a cross-sectional study design, 168 women without clinical evidence of CAD (115 with TS and 53 without TS) were assessed for the presence and volume of subclinical CAD using coronary CT angiography. Karyotype, the presence of congenital heart defects and conventional cardiovascular risk factors were also registered. Comparative analyses were performed (1) between women with and without TS and (2) in the TS group, between women with and without subclinical CAD. The prevalence of CAD, in crude and adjusted analyses, was not increased for women with TS (crude prevalence: 40 [35%] in TS vs. 25 [47%] in controls, p = 0.12). The volume of atherosclerosis was not higher in women with TS compared with controls (median and interquartile range 0 [0-92] in TS vs. 0 [0-81]mm3 in controls, p = 0.29). Among women with TS, women with subclinical CAD were older (46 ± 13 vs. 37 ± 11years, p < 0.001), had higher blood pressure (systolic blood pressure 129 ± 16 vs. 121 ± 16mmHg, p < 0.05) and were more frequently diagnosed with type 2 diabetes (5 [13%] vs. 2 [3%], p < 0.05). Karyotype or congenital heart defects were not associated with subclinical CAD. Some women with TS show early signs of CAD, however overall, not more than women without TS. Conventional cardiovascular risk factors were the principal determinants of CAD also in TS, and CAD prevention strategies should be observed.ClinicalTrial.gov Identifier: NCT01678261 ( https://clinicaltrials.gov/ct2/show/NCT01678261 ).

Socio-Demographic Characteristics of Acute Myocardial Infarction Patients in Bangladesh

Background: The impacts of socio-demographic characteristics on acute myocardial infarction (AMI) are not well understood and have not yet been studied much more in our country. Acute myocardial infarction is the most common form of coronary heart disease and the single most important cause of premature death worldwide.Objective: The aim of this study was to assess the impacts of the socio-demographic characteristics on AMI patients and to investigate the association between socioeconomic status and its various indicators and the risk of acute myocardial infarction (AMI). This study will help in awareness building in reducing AMI by early detection of socio-demographic variables.Patients and methods: This was a prospective observational study consisted of 325 persons of AMI patients who were aged &gt;20 years. Patients with first time AMI arriving in Coronary Care Unit (CCU) of Rajshahi medical college during the period of 2012-2014, were included. Data were collected through interview.Results: Among the AMI patients, male were more sufferer than female (68.3% vs. 31.7%) and male and female ratio was 2.15:1.0. Highest percentage of education was up to primary level (53.85%). Most of studied subjects (92.0%) monthly income were ≤15000. More than half (59.38%) of the studied population were from rural area, mostly they were Muslim (94.46%) and smokers (50.15%). The mean±SD age of the acute Myocardial infarction patients was 53.75±11.64 years. Mean age of the female patients were a little bit higher than the male patients (female 54.28±11.78 vs. male 53.51±11.63). Highest percentage was in the age group 51-60 years (32%) followed by 41-50 (26.8%) and then age group &gt;60 (23.7%). Among the male patients highest percentage was in the age group 51-60 years (31.1%) followed by 41-50 years (27%) and then age group &gt;60 (24.3%). However, among the female patients, highest percentage were in the age group 51-60 years (34%) followed by 41-50 years (26.2%), and then age group &gt;60 (22.3%). Acute Myocardial infarction patients was more in age group &gt;40 years of age. Interestingly after 60 years of age occurrence of AMI was low in both sexes.Conclusion: Both sex and age influenced AMI. An association was also found among educational level, monthly income, residence area, religion, smoking habit and AMI.TAJ 2016; 29(1): 16-20

Efeitos do sulfato de magnésio e da milrinona sobre o vasoespasmo cerebral após hemorragia subaracnoidea por aneurisma: estudo randômico

BackgroundAneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. MethodsThe study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500mg.day−1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5μg.kg−1.min−1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity≥120cm.s−1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). ResultsThe mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p<0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p=0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p=0.036, p=0.012, p=0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p=0.012). ConclusionsThe incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.

Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study

BackgroundAneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. MethodsThe study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500mg.day−1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5μg.kg−1.min−1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity≥120cm.s−1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). ResultsThe mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p<0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p=0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p=0.036, p=0.012, p=0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p=0.012). ConclusionsThe incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.

Regional coronary endothelial dysfunction is related to the degree of local epicardial fat in people with HIV

Background and aimsCoronary artery disease (CAD) is now an important cause of premature death in people with HIV but the causes of accelerated CAD are poorly understood. Epicardial adipose tissue (EAT) is metabolically-active and thought to contribute to CAD development. We tested the hypothesis that abnormal coronary endothelial function (CEF), an early marker and mediator of atherosclerosis, is related to the amount of local pericoronary EAT in HIV. MethodsWe studied 36 participants with HIV and no CAD (HIV+ CAD-), 15 participants with HIV and known CAD (HIV+ CAD+), and 14 age-matched, healthy participants without HIV (HIV-CAD-). To measure CEF, coronary MRI was performed before and during isometric handgrip exercise (IHE), an endothelial-dependent stressor. EAT was measured with MRI at the same imaging plane as CEF. ResultsCEF was significantly depressed, as measured by IHE-induced % coronary cross sectional area (CSA) change, in HIV+ CAD- and HIV+ CAD+ as compared to HIV-CAD-participants (p<0.0001). EAT thickness was significantly greater in HIV+ CAD- and HIV+ CAD+ participants as compared to HIV-CAD-participants (p=0.001). There was a significant inverse relationship between CEF and local EAT thickness and area (R = −0.48 and R = −0.51 respectively, p<0.0001 for both) among participants with HIV even after adjustment for cardiovascular risk factors. In participants with multiple CEF measures, CEF was lower in segments with higher EAT, other factors being equivalent. ConclusionsThere is a significant relationship between increased metabolically-active EAT and depressed local CEF in people with HIV, consistent with the hypothesis that increased epicardial fat contributes to accelerated CAD in persons with HIV.

TCTAP A-128 Raised Level of Cardiac Troponin I (50 Folds Upper Limit of Normal) Is a Sensitive and Specific Marker for Extent of Coronary Artery Disease in First Attack of Non-ST Segment Elevation Myocardial Infarction in Bangladeshi Population.

Coronary heart disease is the most common form of heart disease and is the single most important cause of premature death in developed world. Recognizing a patient with ACS is important because the diagnosis triggers both triage and management. Cardiac Troponin-I (cTnI) is 100% tissue-specific for

Structural and Biophysical Analysis of Hypertrophic Cardiomyopathy-Linked Titin Missense Variants

Cardiomyopathies are an important cause of premature death from heart failure, ventricular arrhythmia and stroke. The most common subtype, hypertrophic cardiomyopathy (HCM), is an inherited disease that results in the thickening of the myocardium, whilst at the cellular level the sarcomere - the contractile unit of cardiac and skeletal muscle - is disrupted. The advent of high throughput sequencing has enabled the identification of variants in physiologically relevant genes, aiding the search for causative mutations of HCM. One gene that is now amenable to sequencing in HCM patients is TTN, which encodes Titin, a multidomain, multifunctional filament that spans half a sarcomere in striated muscle. Titin is essential for sarcomere assembly and plays a variety of roles in the heart, including providing passive muscle elasticity during the contraction-relaxation cycle and signaling via its kinase domain. The protein contains over 300 immunoglobulin and fibronectin III domains, the majority of which are located along the myosin-associated A-band region of the sarcomere. Whole exome sequencing of a cohort of HCM patients has identified a large number of missense variants in Titin, particularly in the A-band region of the protein. Whilst many of the variants are likely neutral, a number are enriched when compared to their frequency in control cohorts. We present here the structural and biophysical analysis of five Titin A-band fibronectin III domains and their associated variants enriched in either the HCM cohort or in the general population. The crystal structures of two wild type and HCM-linked variant domains have been determined, and thermal denaturation experiments demonstrate both variants have a reduced stability when compared to their wild type counterparts, suggesting a causal role in HCM and hinting at a method to distinguish pathogenic from non-pathogenic Titin missense variants.

The Hypotensive Effect of Homoeopathic Medicines In The Management Of The Patients Suffering From Uncomplicated Essential Hypertension - A Prospective, Observational Study

Background: The World Health Organization (WHO) considersHypertension (HT) as one of the most important causes of premature death worldwide.It is directly responsible for 57% of all deaths due to stroke and 24% of all deaths due to coronary heart disease deaths in India. Recent studies conducted on Indian population have shown that the prevalence of hypertension in urban areas is 25%,whereas, it is 10% in rural areas. 1 According to the statistics of the WHO, homoeopathy is the second most useful health care system in the world. However, a meta-analysis in 2005 concluded that the clinical effects of homoeopathy are nothing but placebo effects. 2 Although a conflicting conclusion was arrived at earlier in 1997 by another meta-analysis. 3 The aim of this study was to evaluate whether individualized homoeopathic medicines could produce any significant hypotensive effect different from placebo in patients with essential hypertension by comparing the lowering of blood pressure level between groups. Settings and Design: A prospective, double-blind, randomized, placebo-controlled, parallel-arm clinical trial was conducted atDr.NishantDaryani’s clinic, Jaipur &Dr.NiveditaPattanaik’sclinic, Udaipur.(Raj.). Material and Methods:Total 233 hypertensive patients were assessed for eligibility, out of which 150 were enrolled and randomized for the study (verum/homoeopathy 70 &control/placebo 80). Among 150 patients 18 were dropped out during the study while 132 remained under regular follow up (verum 64, control 68). The outcome measures were assessed at the end of 3 and 6 months. Results: The baseline data were not significantly different between the groups. After 6 months, mean Systolic Blood Pressure (SBP) in the homoeopathy group reduction was 26.6 mm Hg (95% CI 21.5, 31.7) whereasSBP in the placebo group increased by 3.6 mm Hg (95% CI -8.7, 1.5). Similarly, the mean Diastolic Blood Pressure (DBP) in the homoeopathy group reduced by 11.8 mm Hg (95% CI 9.2, 14.4) whereas DBP increased by 1.6 mm Hg (95% CI -3.6, 0.4) in the placebo group. Repeated measures ANOVA also showed significant difference (P=0.0001) between the groups. Detailed case recording of each patient was doneon Case recording format (CRF) following guidelines laid down by Master Hahnemann in Organon of Medicine 4 and Kent's philosophy 5 .Wherever required repertorization was done from synthesis repertory using RADAR software version 10.5 6 and final selection of medicine was done through Homoeopathic MateriaMedica. Frequently prescribed medicines were Natrummur.,Lachesis, Glonoine, Gelsemium, Bryonia alba, Aurum met.,Pulsatilla, Sulphur, Digitalis and Belladonna.

An observational study of the direct costs related to hospital admissions, mortality and premature death associated with liver disease in Portugal.

BackgroundLiver disease, one of the most common causes of hospitalization worldwide, is particularly prevalent in Europe. This study aimed to determine the number of hospital discharges and admissions, mortality, premature death and costs associated with liver disease from the perspective of the National Health Service in Portugal.MethodsA descriptive, retrospective analysis of data from 97 hospitals between 2000 and 2008, and mortality data for 2011 collected from the Portuguese National Institute of Statistics. The 9th and 10th revisions of the international classification of diseases were used to establish diagnoses. National data on demographics, average length of stay, in-patient mortality and direct costs associated with hospital admissions and liver transplantation were compared for the most common liver diseases. Mortality and premature death were compared using the potential years of life lost (PYLL) index.ResultsThe annual mean number of discharges for liver disease was 11,503 between 2000 and 2008. Most cases of liver disease were diagnosed in men (70.4 %) and the prevalence of liver disease peaked in patients aged from 20 to 64 years (60.7 %). Alcoholic cirrhosis was the most frequent liver-disease diagnosis leading to discharge (38.6 %). In addition, alcoholic cirrhosis emerged as the main cost-driver, accounting for €26,818,930 (42.6 %) of the total cost imposed by liver disease. Overall, chronic hepatic disease was the 10th most common cause of mortality in Portugal in 2011, causing 21.8 deaths per 100,000. Chronic hepatic disease and hepatocellular carcinoma are even more important causes of premature death, ranking third based on PYLL.ConclusionIn 2011, liver disease was the 10th most common cause of death and the third most important cause of premature death in Portugal. Alcohol cirrhosis was the leading cause of liver-related hospital admissions between 2001 and 2008. It appears that liver disease imposes a considerable social and economic burden on Portugal. Our results suggest that educational, legislative and therapeutic interventions to prevent morbidity, mortality and premature death from liver disease are urgently required to minimise the economic and clinical burdens.