The Attack on Coronary Disease: Should it be before, during or after?

The whole idea of primary prevention of arterial disease stems from the Framingham philosophy (Framingham Heart Study, 1948), which is based on an epidemiological approach. There is no doubt that this is has been successful in leading to a great reduction in smoking, correlating with a great reduction in coronary disease.

 One might consider the possibility of attacking the late phase of the thrombotic process rather than the initiation. The most popular idea about that is a plaque rupture leaking material that causes platelet activation and adhesion. However, in our practice coronary angiography showed that approximately only half the culprit lesions were eccentric, and half concentric. Concentric lesions are not likely to respond to statin, and that may explain why non-ST elevation acute coronary syndromes have outnumbered ST elevation infarcts in frequency since 2000. Read more>>>>>>>>>>>

Role of Dietary Components in Modulating Hypertension

Hypertension is estimated by the Centers for Disease Control and Prevention to affect approximately 30% of adults in theUnited States. It is a significant factor in the pathogenesis of a number of diseases, including obesity, cardiovascular disease, and stroke. 

Hypertension itself can be caused by unhealthy lifestyle habits like alcoholism, drug addiction, smoking, high stress, or obesity, and certain non-modifiable attributes like age, gender, hereditary and genetic constitution, and racial or ethnic disparities. Hypertension to an extent correlates to the prevailing socioeconomic and geographical characteristics of a region, as well as to individual behavioral factors, and can pose a significant public health concern in populations defined by economic hardship, poverty, reduced health care access, low health literacy, and lack of resources due to geographic isolation.  Read more>>>>>>>>>>>>>>

Aerobic Training Effect on Blood S-Klotho Levels in Coronary Artery Disease Patients

Aerobic exercise and Klotho gene expression could reduce the risk of cardiovascular events in patients with prior coronaryartery disease (CAD), thus aerobic exercise may decrease the risk of mortality. 

Aerobic exercise can decrease the incidence and severity of cardiac events during exercise among an unselected group of patients with stable CAD. In addition, exercise training improves endotheliumdependent vasodilatation both in epicardial coronary vessels and in resistance vessels in patients with CAD . Patients with significant CAD present lower soluble concentrations of α-Klotho (s-Klotho), as well as reduced levels of Klotho gene expression in the vascular wall. Read more>>>>>>>>>>>>>>

High-Volume Hospitals for Patients Affected by Thoracic Aortic Diseases. Do We Really Need them?

The term “thoracic aortic disease” (TAD) includes a wide range of aortic diseases with variable clinical presentations and prognosis. The Global Burden Disease 2010 project demonstrated that the overall global death rate from aortic aneurysms and aortic dissection increased from 2.49 per 100000 to 2.78 per100000 inhabitants between 1990 and 2010, with higher rates for men. 

At the same time, admissions for thoracic aortic aneurysms have increased from 4.4 to 9.0 per 100000 in the UK, mainly due to an increase in elderly patients, over 75 years of age. Despite this emerging epidemic, standard of care for TAD has not been established. The 2010 American Heart Association (AHA) guidelines for the management of TAD include a level I recommendation for the “evidence-based referral” of TAD patients, limiting their care to large volume centres, with experienced physicians, and supporting teams.            Read more>>>>>>>

Recombinant Human Elastase Treatment of Cephalic Veins

Vonapanitase (formerly PRT-201), is a recombinant human Chymotrypsin-like Elastase family member 1 (CELA1) and was previously described as type I pancreatic elastase. 

This novel drug is currently in Phase 3 human clinical trials (PATENCY-1 and PATENCY-2) in CKDpatients undergoing AVF placement (clinicaltrials.gov; NCT02110901 andNCT02414841). The goal of the clinical trials is to establish the safety profile of vonapanitase and determine if vonapanitase applied to the outflow vein at the time of AVF creation can improve the success and longevity of AVF surgery. After vessel injury from AVF surgery there is often the development of neointima hyperplasia from smooth muscle-like cells that migrate to the vessel intima. This neointimal hyperplasia can progress to stenosis or occlusion and cause AVF maturation failure which is a huge clinical problem. Read more>>>>>>>>>>>

Usefulness of Α-Lipoc Acid, Leucoselect and Ginkgoselect Phytosoma in Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) is a common pathology affecting mainly lower limbs. Vein-related problems include a wide spectrum of a several clinical signs that vary from minimal superficial venous dilation to chronic skin changes with ulceration. 

Symptoms usually reported by patients are pain, leg cramps, aching and itch. Particularly, itch has been shown to significantly influencing the quality of life of CVI patients. The aim of our work was to verify the usefulness of α-lipoc acid, Leucoselect® and Ginkgoselect® phytosome in patients with CVI. Leucoselect® Phytosome® is a formulation of lower procyanidin oligomers from grape seed and soy lecithin to further improve their absorption. Alterations in the venous microcirculation are the main risk factors in CVI and procyanidin supplement has shown to improve the microcirculation and increase the capillary resistance.  Read more>>>>>>>>>>

Recent Perspectives on Left Main Bifurcation Interventions

Significant unprotected LM disease constitutes approximately 5-10% of patients undergoing coronary angiography. Randomized clinical trials (RCTs) have demonstrated a higher rate of repeat revascularization after percutaneous coronaryintervention (PCI) compared with coronary artery bypass grafting (CABG), but a lower incidence of cerebrovascular events; no differences were reported in overall major adverse cardiovascular events (MACEs). 

Although CABG has been the gold standard therapy for LM disease until recently, significant innovation in stent technology, revascularization techniques and antithrombotic therapies make PCI feasible. Treatment of ostial and mid-shaft has shown excellent outcomes with minimal mortality and long-term complications compared with distal LM bifurcations. Lack of RCTs addressing LM bifurcation has led to uncertainties regarding optimal stenting strategy. Read more>>>>>>>>>>>

Giant Cardiac Fibroma in a Completely Asymptomatic Teenager

Primary cardiac tumors are extremely rare, with a reported incidence ranging from0.0017 to 0.019%, most of them are benign and fibroma is the second for prevalence after rhabdomyoma. 

The most frequent sites of occurrence for cardiac fibroma are the left and right ventricles and the interventricular septum. Clinical presentation is often subtle and is influenced by size and location of the mass, which could determine heart failure, malignant arrhythmias and sudden cardiac death. Echocardiography is essential for the diagnosis, nevertheless computed tomography (CT) and magnetic resonance imaging (MRI) better define size, shape, and mostly the anatomical relationships of the lesion. Read more>>>>>>>>>>>>

Summative Evaluation of Physician-Pharmacist Collaboration Management

As the health care system adapts to the growing population living with chronic disease there has been a shift in the delivery of primary care towards a team-based, patient-centered model. The benefits of including a pharmacist as amember of a collaborative medical team have been well established. Several systematic reviews and meta analyses have shown the positive impact pharmacists have on improving BP control and managing other cardiovascular risk factors.

The American College of Clinical Pharmacy (ACCP) Ambulatory Care Practice and Research Network (PRN) recently published a paper stressing the importance of pharmacists in the optimization of medication management in the Patient Centered Medical Home (PCMH) and identify pharmacists as an essential component to the success of the PCMH model.  Read more>>>>>>>>>

Carvajal Syndrome: A Rare Variant of Naxos Disease

Carvajal syndrome also known as ‘Striate palmoplantar keratoderma with woolly hair and cardiomyopathy is a cutaneous condition inherited in an autosomal recessive pattern due to a defect in desmoplakin gene. The skin disease presents as a striate palmoplantar keratoderma particularly at sites of pressure. 

The patient is at risk of sudden cardiac death due to dilated cardiomyopathy associated with this entity. A variant of Naxos disease, reported as Carvajal syndrome, has been described in families from India and Ecuador. Clinically, it presents with the same cutaneous phenotype and predominantly left ventricular involvement.

Case Report : 11 years old boy presented with cough, breathlessness and easy fatigue ability for 3 months duration. On general examination the pt had fine brittlle lusterless scalp hair, pallor, stomatitis, keratotic skin over palm, sole and lower half of both lower limbs.  Read more>>>>>>>>>>>>>>>

Oximeter Behavior While Using a Tourniquet

Pulse oximetry is a noninvasive technique widely used. It was developed during the 1970’s and its main use is to measure the oxygen saturation level of arterial peripheral blood, an indicator of oxygen supply. Conventionally, a pulse oximeter has both a coherent light source, such as a LED, emitting red (660 nm) and infrared (940 nm) light, and aphotodiode detector to measure the absorption of light. 

The probe is typically attached to a patient's finger or toe. For a finger, the probe is configured so that the emitters project light through the tissue. The photodiode is positioned opposite the LED in order to detect the transmitted light as it emerges from the finger tissues. The pulse oximetry monitor determines oxygen saturation by analyzing the differential ratio absorption of the two wavelengths emitted by the probe. It alternately activates the probe LED emitters and reads the resulting current generated by the photodiode detector. Read more>>>>>>>>>>>>>>