Naresh Sen

BETTER CARDIOVASCULAR OUTCOMES OF COMBINED SPECIFIC INDIAN YOGA AND AEROBIC EXERCISE IN OBESE CORONARY PATIENTS WITH TYPE 2 DIABETES

Major cause of death across the world is coronary artery disease. Its severity depends on various risk factors like hypertension, diabetes, smoking, dyslipidemia, obesity, stress and others. Randomized clinical study done in last 3 years duration . 750 patients enrolled in this study who had been

Lifestyle intervention with integrated medicine in primary and secondary prevention for common cardiovascular disorders

T term pre-hypertension is employed when systolic blood pressure ranges from 120 to 139 mmHg or diastolic blood pressure ranges from 80 to 89 mmHg. This new classification was introduced due to the excessive mortality and high conversion rates to clinical hypertension among individuals with a marginal increase in blood pressure. Besides being associated with an increase in the incidence of cardiovascular events, prehypertension is an intermediate pathway to full hypertension, which makes adequate diagnosis and treatment essential. Ambulatory blood pressure monitoring is a good tool for the evaluation overall of cardiovascular risk and important to the diagnosis and prognosis of hypertension. This measure can contribute to the stratification of individuals with prehypertension based on variables such as central blood pressure and arterial stiffness with the aim of defining individuals with prehypertension that could benefit from treatment. Moreover, aspects involved in vascular remodeling and arterial stiffness are highlighted among the different physiopathological mechanisms that characterize the multifactor etiology of high blood pressure. Recently, there has been increasing interest in the study of proteolytic enzymes, such as metalloproteinases (MMPs), which are found at elevated levels in patients with poor cardiovascular outcomes. The increased activity of MMPs can impair vascular relaxation and consequently contribute to hypertrophy of the arterial walls, leading to vascular dysfunction and contributing to an increase in arterial stiffness. Despite reports of this association, few studies in the literature have addressed MMP levels and their association with arterial stiffness in populations with different degrees of arterial hypertension, especially those with prehypertension.The rise of vagal tone facilitated the activity of pulmonary veins and played an important role in the initiation of AF [1]. Autonomic nerve stimulation shortens AERP, decreases the wavelength of atrial reentrant circuits and increases dAERP, thus, promoting the stability of AF [2]. Several studies have demonstrated that additional ablation of epicardiol ganglionated plexi (GP) improved success rate in catheter ablation of AF after circumferential isolation of pulmonary veins [3,4]. But in long term follow-up, the effect of GP ablation is limited due to high reoccurance rate of AF [5,6].This topic referred about the amazing sudden death of the cardiovascular causes in the young peoples and how we can prevent this unhappy event? It is possible to existing a protocol or an ideal management in this way? We can control the phenomenon? How we can save many lives at young age? Starting from the mentality of the young people how if “ I’m young and I’m healthy”, I have performed this book to be an alarm signal for the young people in general and young professional athletes but also for the physicians who are required to have a very serious and responsible attitude in their medical daily practice. A young person is not necessarily healthy. This is the reason why I have decided to write this book, after many observations of real life cases, and because I think, as physicians, we can make something very important for these young people to prevent the sudden death at young age. We have to employ high efforts in our medical practice to decrease the mortality at young age.Methods and findings : Using atrial samples from 259 patients (51 with permanent AF) and 36 goats (24 with AF), we show that atrial-specific upregulation of microRNA-31 (miR31) in goat and human AF causes dystrophin [DYS] translational repression and accelerates mRNA degradation of neuronal nitric oxide synthase [nNOS] leading to a profound reduction in atrial DYS and nitric oxide availability. Prediction algorithms and reporter assays established DYS and nNOS as miR31 targets. In actinomycin D-treated myocytes from patients in sinus rhythm, miR31 accelerated nNOS (but not DYS) mRNA decay. Physical interaction between miR31 and DYS or nNOS within the RNA induced silencing complex [RISC] in atrial myocytes from patients with AF [hAFm] was confirmed by immunoprecipitation of Argonaut 2. MiR31 overexpression and/ or disruption of nNOS signaling (with nNOS-siRNA or secondary to nNOS gene deletion) recapitulates hallmark features of AF-induced remodelling (shortening of action potential duration [APD] and loss of APD rate-dependency) and significantly increases AF inducibility in mice in vivo. By contrast, silencing miR-31 in hAFm restores dystrophin and nNOS and normalizes atrial electrical properties. Masking miR31 binding site on the DYS increases both DYS and nNOS protein (but not mRNA), in keeping with a stabilising effect of DYS on nNOS protein. Indeed, K48-linked polyubiquitination and proteasomal degradation of nNOS were increased in hAFm.Methods and findings : Using atrial samples from 259 patients (51 with permanent AF) and 36 goats (24 with AF), we show that atrial-specific upregulation of microRNA-31 (miR31) in goat and human AF causes dystrophin [DYS] translational repression and accelerates mRNA degradation of neuronal nitric oxide synthase [nNOS] leading to a profound reduction in atrial DYS and nitric oxide availability. Prediction algorithms and reporter assays established DYS and nNOS as miR31 targets. In actinomycin D-treated myocytes from patients in sinus rhythm, miR31 accelerated nNOS (but not DYS) mRNA decay. Physical interaction between miR31 and DYS or nNOS within the RNA induced silencing complex [RISC] in atrial myocytes from patients with AF [hAFm] was confirmed by immunoprecipitation of Argonaut 2. MiR31 overexpression and/ or disruption of nNOS signaling (with nNOS-siRNA or secondary to nNOS gene deletion) recapitulates hallmark features of AF-induced remodelling (shortening of action potential duration [APD] and loss of APD rate-dependency) and significantly increases AF inducibility in mice in vivo. By contrast, silencing miR-31 in hAFm restores dystrophin and nNOS and normalizes atrial electrical properties. Masking miR31 binding site on the DYS increases both DYS and nNOS protein (but not mRNA), in keeping with a stabilising effect of DYS on nNOS protein. Indeed, K48-linked polyubiquitination and proteasomal degradation of nNOS were increased in hAFm.

A rarest case of Actinomycosis induced pericardial & pleural effusion

Background: The cyanotic heart disease Tetralogy (TOF) is one of the common congenital heart disease in children. The catheterization of such patients still considered as important diagnostic step before surgical correction. The prevalence of abnormal coronaries in Tetralogy (TOF) has been reported up to 9% in different studies. Coronary abnormalities are usually difficult to delineate intraoperatively because of thick epicardial fat layer and adhesions particularly after BT shunt. Aim: To find out coronary abnormalities in Tetralogy of Fallot (TOF) children seen in our cardiac unit. Place and Duration of Study: The study was conducted in the Children hospital & Institute of Child Health, Lahore, Pakistan from January 2006 to December 2014. Methods: A Retrospective descriptive study was done .Records of all Patients with Tetralogy of Fallot from 9 months to 16 years whose cardiac catheterization was done before going to surgical repair in our unit were selected in this study. Two Non-selective aortic root angiogram were done i.e., standard 45 left anterior oblique (LAO) and 20 cranial and 30 right anterior oblique (RAO) views were taken to look for coronaries course. Data was analyzed in SSPS-19. Results: Total 662 patients with Tetralogy underwent cardiac catheterization were included in the study. 65.4% were male while 34.6% were female. The mean age was 69±43.14 months. 94.4% of patients with Tetralogy had a normal coronary anatomy while 5.6% of patients with Tetralogy had abnormal coronary course. Out of these patients with abnormal coronary, the most common was detected single origin of coronary artery that is 2.9% of cases. Out of which 12 patients had common origin from left sided sinus i.e., 1.8% and 7 patients had common origin from right sided sinus i.e., 1.1%. 2.6% of patients with abnormal coronary had coanal branch crossing right ventricular outflow track (RVOT) anteriorly and 0.2% of patients with abnormal coronaries had coanal branch crossing RVOT posteriorly. Conclusion: Coronary artery anomalies and its course in Tetralogy patients were detected upto 5.6% of the cases. Single origin coronary artery abnormality was found to be the most common abnormality in this study.Case presentation: A 66-year-old male presented to us with 3 days history of chest pain and difficulty breathing. He is known to be hypertensive. In the emergency room, patient has systolic blood pressure >190. Chest X-ray showed widening of mediastinum. CT angiography of chest and abdomen showed an acute dissection of the thoracic aorta extending from the mid ascending aorta to the infra-renal aorta suggestive of Stanford type A aortic dissection. Transthoracic echocardiography revealed a calcified intimal flap just beyond the distal arch. Moreover, large partially calcified intimal flap was present in the abdominal aorta with no proximal clear cut extension. Normal ejection fraction was reported with dilated aortic root, dilated aortic arch, and large pericardial effusion with no evidence of cardiac tamponade. Trans-esophageal echocardiography was done later, and it revealed a partially calcified intimal flap in the distal portion of the arch and in the descending thoracic aorta in concordance with the trans-thoracic echocardiogram findings and no abnormalities were reported in the ascending aorta. These findings were significantly consistent with Stanford type B aortic dissection. Due to the discrepancy of these tests, imaging studies were reviewed, and repeated CT chest with contrast was obtained and surprisingly confirmed that he had Stanford type B aortic dissection, with the dissection starting distal to the left subclavian artery and intact ascending aorta. Medical treatment started, and repeated CT angiography was obtained and it confirmed type B aortic dissection. One week after discharge, patient was readmitted with severe neck pain and difficulty breathing. CT chest without contrast showed grossly stable appearance of type A dissection consistent with the first CT angiography. Cardiothoracic surgery immediately reevaluated the situation and recommended surgical intervention.Results: Women constituted 55.7% of our patient population, while men represented the remaining (44.3%). Mean age was 73.5 ± 12.6 years. History of CAD was documented in 56.6% of patients. Overall, CAD was not predictive of poor outcome and cardiovascular death. Poor outcome was observed in more than half of HFpEF patients with history of CAD and in only about one third of those without CAD, 56.1% and 38.6%, respectively (P=0.1). Moreover, the number of the diseased coronary artery vessels on angiogram was not a significant predictor of poor outcome (P=0.17).H Chloro Quine (HCQ) is an antimalarial drugs that has been used for treatment of connective tissue disorders. Unlike other agents, Hydroxychloroquine has gained popularity because of its relatively safe profile and less toxic side effects. Hydroxychloroquine cardiotoxicity is a rare disease but a potentially fatal heart condition. To date, no clear guidelines or protocols exist to monitor patients for development of the cardiac side effect of HCQ. In this brief review we will focus on Hydroxychloroquine Cardiotoxicity, its clinical presentation, diagnosis,potential risk factors that are predisposing to the cardiomyopathy and variables that affect the outcome of this rare for of cardiomyopathy.Method: This longitudinal study was conducted over a year. The families of children with congenital heart disease who were being managed for chronic heart failure in the clinic were recruited for the study. With the aid of a structured questionnaire, data were collected on a monthly basis for three consecutive months, on the family’s monthly income, cost of anti-failure medicines, transportation and the number of man-hours spent on clinic visitation. The percentage of the mean monthly income spent on medicines, transportation and the total cost of care were also computed.