Metabolic syndrome: are we at risk?

The metabolic syndrome also called syndrome X, is a constellation of interrelated risk factors of metabolic origin--metabolic risk factors--that appear to share insulin resistance as a possible pathogenetic factor that directly promote the development of atherosclerotic cardiovascular diseases and increase the risk for developing type 2 diabetes mellitus. The recommended first step for treatment of metabolic syndrome is lifestyle modifications such as weight loss, aerobic exercise, smoking cessation, and improved diet which independently improve insulin resistance and slow progression to type 2 diabetes mellitus. Even though success achieved through lifestyle modification is limited, the significance of it cannot be overemphasized. Specific dietary changes that are appropriate for addressing different aspects of the syndrome include reducing saturated fat intake to lower insulin resistance, reducing sodium intake to lower blood pressure, and reducing high-glycemic-index carbohydrate intake to lower triglyceride levels. Furthermore, drugs able to reduce insulin resistance, such as metformin and thiazolidinediones, already in the therapeutic armamentarium of type 2 diabetes, could be used in subjects with the metabolic syndrome as a preventive measure.

Analysis of clinical factors affecting the restenosis following percutaneous coronary intervention.

Coronary heart disease (CHD) is a leading cause of morbidity and mortality across the world. Percutaneous coronary interventions (PCI) including angioplasty and/or stenting have revolutionized the effect management of ischemic syndromes in CHD and their symptoms. However, the superimposition of iatrogenic mechanical injury (PCI procedure) on coronary atherosclerosis initiates restenosis that may complicate the patient's clinical course like recurrence of angina, myocardial infarction and cardiac insufficiency. In order to study the possible association of clinical risk factors on the incidence of restenosis; clinical predictors were determined in 98 patients (81 males and 17 females) who all undergone follow-up coronary angiography within 8.2 months after PCI. The mean age was 59.7years (40-80years). 83 patients had recurrence of angina however 15 patients had no symptoms at the follow up. The multivariate analysis of the clinical predictors demonstrated that a significant higher risk of restenosis after PCI was found in patients with hyperlipidemia p<0.05, [RR=1.311(1.018-1.687)]. Longer the history of hyperlipidemia the angina recurrence time is shorter. Besides restenosis is also closely related to male patients (p<0.10). Finally, this study strengthens evidence that restenosis following PCI is higher in patients with hyperlipidemia, and longer the history of hyperlipidemia the recurrence time of angina is shorter.

Study of prevalence of hypertension in Chronic Obstructive Pulmonary Disease patients admitted at Nepal Medical College and Teaching Hospital.

A retrospective study of 237 cases of Chronic Obstructive Pulmonary Disease (COPD) patients admitted in medical ward of Nepal Medical College Teaching Hospital (NMCTH) was performed to find out the prevalence of hypertension in such COPD subjects. The prevalence of COPD amongst the total number of patients admitted at NMCTH medical ward was 17.3%. Prevalence of COPD was more after the onset of middle age, the peak was found to be at the age of 60-69 years. Out of these COPD subjects, 98 patients (37 patients were known case of hypertension) had hypertension. Thus prevalence of hypertension was 41.3% in COPD subjects studied. Prevalence increased with age after the age of 50 years and the highest prevalence was at the age of 60-69 years which directly correlates with the prevalence of COPD. The prevalence of hypertension in COPD patients was significantly higher than the normal population that may reflect COPD itself as a risk factor for developing hypertension. A larger and detailed study is needed to confirm such finding.

Dysphagia as a presenting symptom in a case of dermatomyositis and occult gastric malignancy.

A case of dermatomyositis in a 64 yrs old male with occult gastric malignancy is presented along with a brief review of literature.

Study of cases of hypertension admitted at Nepal Medical College Teaching Hospital.

Hundred cases of hypertension admitted to medical ward at Nepal Medical College and Teaching Hospital were studied and analysed. They constituted 9.4% of the total admitted patients in the medical ward. Association of hypertension with other diseases is highlighted. Thirty two percent of these hypertensives were diabetic and 22.0% of hypertensives also had Chronic obstructive airway disease (COAD). Different types of complications of hypertension seen in the studied subjects are mentioned. Only 19.0% of hypertensives had their blood pressure controlled and the rest were uncontrolled hypertensives.