ABSTRACT
Rheumatic Fever (RF)/ Rheumatic Heart Disease (RHD) is the result of autoimmune response triggered by group A Beta-haemolytic streptococcal pharyngitis leading to immune-inflammatory injury to cardiac valves. It is practically disappeared in developed countries. However, it continues to be a major cause of disease burden among children, adolescents, and young adults in low-income countries and even in high-income countries with socioeconomic inequalities. For decades, many cases of Acute Rheumatic Fever (ARF) and RHD were missed and were denied the secondary prophylaxis, as a result these patients used to end up with complications and untimely death. Advanced understanding of the echocardiography can prevent both under diagnosis and over diagnosis and thus help in management strategy. Another new advancement in recent past is the mitral valve repair, which is technically demanding, and the results are acceptable in experienced cardiac surgical units. Whenever feasible, valve repair should be preferred over valve replacement since it precludes the need for anticoagulation and future risks of prosthesis dysfunction.
ABSTRACT
Objective Omega-3 fatty acids, especially alpha-linolenic acid (ALA), which are present in nuts may reduce cardiovascular disease (CVD) risk, by changing vascular inflammation and improving endothelial dysfunction. The objective of the study was to evaluate the acute effects of two different diets, one containing walnuts and the other almonds on endothelial function. Methods Twenty-seven overweight volunteers underwent a randomized 2-period, crossover, controlled intervention study. The subjects were given either walnut or almond diets which varied in monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) content. The walnut diet provided 23.1% energy from PUFA and the almond diet provided 7.6% energy from PUFA. Endothelial function was assessed physiologically by flow-mediated dilation (FMD) and biochemically by sVCAM (soluble vascular cell adhesion molecules). Results The walnut diet significantly improved FMD (p = 0.004) and decreased sVCAM (p = 0.009) whereas the almond diet tended to improve FMD (p = 0.06) and significantly decreased sVCAM (p = 0.004). Conclusion Both walnut and almond diets improved FMD and sVCAM and there was no significant difference in physiological and biochemical markers between the two diets.
ABSTRACT
BACKGROUND: We evaluated the hospital population for the prevalence of the metabolic syndrome with the help of clinical variables, such as abdominal waist circumference, biochemical variables and ultrasonic variables. The aim was to define the most sensitive and powerful predictor of the syndrome, as also of premature morbidity and mortality. METHODS: We used clinical and biochemical data from our prospective study: "To Evaluate the Scenario of Metabolic Syndrome in the Hospital-Based Community". The criteria used for the definition of the syndrome were those laid down by the National Cholesterol Eradication Program Adult Treatment Panel III. The modified criteria for Asian Indians, that is, an abdominal waist circumference of greater than 90 cm in men, and above 80 cm in women, were also included. A total of 200 patients (100 males and 100 females) between the ages of 20 and 85 years were clinically and biochemically evaluated for the study. RESULTS: The results using the National Cholesterol Eradication Program Adult Treatment Panel III criteria as well as the modified criteria showed that abdominal waist circumference is the single most accurate (79% and 86.5%, respectively) predictor for determining the metabolic status of an individual (p-value <0.001). The waist circumference cut-off of the modified criteria proved to be a more accurate predictor for males as well as females (69% vs. 84%, and 89% vs. 85%, respectively for the two definitions; p-value <0.001). CONCLUSIONS: An abdominal girth of above 90 cm in males and above 80 cm in females is a far more powerful clinical predictor of the metabolic syndrome than other clinical, biochemical and ultrasonic variables (p-value <0.001). This may be considered in the context of premature morbidity and mortality.