Samuel Ward Casscells

Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34 892 subjects

Abstract Aims To determine whether influenza can trigger heart attacks, we investigated the impact of influenza epidemics on autopsy-proven coronary deaths. Methods and results We studied weekly death due to acute myocardial infarction (AMI) and chronic ischaemic heart disease (IHD) in autopsies conducted in 1993 to 2000 in St Petersburg, Russia. We plotted the weekly acute respiratory disease (ARD) counts and influenza epidemics against AMI and chronic IHD deaths. There were 11 892 subjects dying of AMI and 23 000 subjects dying of chronic IHD. Median age was 75 for women and 65 for men. In every year, a peak of AMI and chronic IHD deaths were present and coincided with the influenza epidemic and peak ARD activity. A similar pattern was seen for each subgroup of men, women, subjects 50 years or older, and subjects 70 years or older. When comparing the average influenza epidemic weeks to average off-season weeks, the odds for AMI and chronic IHD death increased by 1.30 (95% confidence interval (CI): 1.08–1.56) and 1.10 (95% CI: 0.97–1.26), respectively. Conclusion Influenza epidemics are associated with a rise in autopsy-confirmed coronary deaths. Influenza vaccination should be advocated for patients at high risk of developing cardiovascular events.

Pomegranate (Punica granatum) purified polyphenol extract inhibits influenza virus and has a synergistic effect with oseltamivir

Influenza epidemics cause numerous deaths and millions of hospitalizations each year. Because of the alarming emergence of resistance to anti-influenza drugs, there is a need to identify new naturally occurring antiviral molecules. We tested the hypothesis that pomegranate polyphenol extract (PPE) has anti-influenza properties. Using real time PCR, plaque assay, and TCID 50% hemagglutination assay, we have shown that PPE suppresses replication of influenza A virus in MDCK cells. PPE inhibits agglutination of chicken red blood cells (cRBC) by influenza virus and is virucidal. The single-cycle growth conditions indicated that independent of the virucidal effect PPE also inhibits viral RNA replication. PPE did not alter virus ribonucleoprotein (RNP) entry into nucleus or translocation of virus RNP from nucleus to cytoplasm in MDCK cells. We evaluated four major Polyphenols in PPE (ellagic acid, caffeic acid, luteolin, and punicalagin) and demonstrated that punicalagin is the effective, anti-influenza component of PPE. Punicalagin blocked replication of the virus RNA, inhibited agglutination of chicken RBCs by the virus and had virucidal effects. Furthermore, the combination of PPE and oseltamivir synergistically increased the anti-influenza effect of oseltamivir. In conclusion, PPE inhibited the replication of human influenza A/Hong Kong (H3N2) in vitro. Pomegranate extracts should be further studied for therapeutic and prophylactic potential especially for influenza epidemics and pandemics.

Informatics Critical to Public Health Surveillance

Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health by effective response management and coordination. As new pressures for early detection of disease outbreaks have arisen, particularly for outbreaks of possible bioterrorism (BT) origin, and as electronic health data have become increasingly available, so has the demand for public health situation awareness systems. Although these systems are valuable for early warning of public health emergencies, there remains the cost of developing and managing such large and complex systems and of investigating inevitable false alarms. Whether these systems are dependable and cost effective enough and can demonstrate a significant and indispensable role in detection or prevention of mass casualty events of BT origin remains to be proven. This article will focus on the complexities of design, analysis, implementation and evaluation of public health surveillance and situation awareness systems and, in some cases, will discuss the key technologies being studied in Center for Biosecurity Informatics Research at University of Texas, Health Science Center at Houston.

Biomarkers of Inflammation as Surrogate Markers in Detection of Vulnerable Plaques and Vulnerable Patients

C-reactive protein (CRP) activates endothelial cells to express adhesion molecules, VCAM and ICAM, and Monocyte Chemotactic Protein, and CRP decreases the availability of nitric oxide. Thus, it is a proinflammatory substance and its serum level is also a predictor of future vascular events. White blood cell counts are independent predictors of cardiovascular events. Lipoprotein-associated phospholipase A2 (Lp-PLA2) may have both proinflammatory and antiinflammatory effects. High Lp-PLA2 levels predict future cardiovascular events. Myeloperoxidase is proinflammatory and its serum level is a predictor of prognosis of cardiovascular events in patients. In troponin-negative acute coronary syndrome (ACS) patients, elevated pregnancy-associated plasma protein-A is an independent predictor of adverse outcome during 6 months of follow-up. Elevated serum amyloid A at hospital admission in patients with unstable angina predicts a poorer prognosis. CD40 and CD40 ligand levels predict prognosis in patients with ACS. The primary proinflammatory cytokines are interleukin-1 and -6 and tumor necrosis factor-α. Increased serum levels of the proinflammatory cytokines are associated with a poorer prognosis, development of congestive heart failure (CHF), and of progressive atherosclerosis. Increased serum levels of interleukin-10 are associated with a better prognosis in patients with coronary artery disease (CAD).

Atherosclerotic Vulnerable Plaques: Pathophysiology, Detection, and Treatment

Atherosclerotic plaque ulceration and fissuring lead to thrombosis and vasoconstriction. Local coagulation factors and blood components, in addition to plaque fissuring and ulceration, contribute to determining the development of thrombosis. Several different imaging procedures, including intravascular ultrasound, elastography, thermography, optical coherence tomography (OCT), magnetic resonance imaging (MRI), and computed tomography (CT) are being developed to detect vulnerable atherosclerotic plaques. Although it is variable among patient groups, perhaps 20% to 40% of patients with acute coronary artery syndromes have more than one vulnerable plaque, suggesting a relatively widespread inflammatory state within the coronary arteries.