Tuesday, 31 October 2017

Pathological Changes in Pulmonary Vasculature after Atrial Fibrillation Ablation


A well-known complication of radiofrequency ablation is pulmonary vein stenosis. We present a complex case of a patient with pulmonary vein occlusion, which developed within a few months after radiofrequency ablation for atrial fibrillation. The pathologic changes seen on lung biopsy, which developed in the months after the ablation are similar to those seen in pulmonary arterial hypertension. A 67-year-old Caucasian male with a history of rheumatoid arthritis and radiofrequency ablation for atrial fibrillation presented with hypoxic respiratory failure and hemoptysis. In the preceding months he had been treated for recurrent pneumonia and high dose corticosteroids for a histopathologic diagnosis of pulmonary capillaritis. A contrast-enhanced computed tomography of the chest revealed total occlusion of the left inferior, left superior, and right superior pulmonary veins with patent flow only through the right inferior pulmonary vein from the right lower lobe. Surgical specimens revealed vascular remodeling similar to Group 1 pulmonary arterial hypertension. This case is important because of the impressive radiographic imaging and histopathological changes seen in a patient with pulmonary veins stenosis and radiofrequency ablation.

We present the case of a patient with known rheumatoid arthritis (RA) who underwent radiofrequency ablation (RFA) for atrial fibrillation (AF). Less than a year after the ablation the patient developed significant pulmonary vein occlusion involving three out of four pulmonary venous outflow tracts. The surgical lung specimens demonstrated marked vascular remodelling and other pathological changes consistent with an occlusive pulmonary vasculopathy.

This case is a 67 year-old Caucasian male who presented with a chief complaint of “coughing up blood.” He had three-month history of hemoptysis and acute-on-chronic hypoxic respiratory failure. His past medical history consisted of RA and AF, having undergone RFA nine months prior to the onset of symptoms. His RA had been treated with methotrexate, sulfasalazine and hydroxychloroquine. In the three months prior to his admission, he had been treated for recurrent pneumonia. Admission physical exam revealed hypoxia with left sided basilar crackles and respiratory accessory muscle use. Contrastenhanced computed tomography of the chest revealed total occlusion of the left inferior, left superior, and right superior pulmonary veins with patent flow only through the right inferior pulmonary vein from the right lower lobe . 

Monday, 30 October 2017

Tracking Calories Has Never Been Easier


Gone are the times of chasing through calorie and starch tallying books to discover the data you have to design Weight misfortune menus. Presently all that and more is in the palm of your hand - in the event that you have the privilege cell phone application, that is. There are several applications for weight watchers, a large number of them free. How might you deal with the decisions? Search for the applications with the sort of instruments you require. 

In case you're checking calories, ensure the application records the amplest assortment of nourishments in the most stretched out assortment of estimations - containers and ounces and grams. Since decreasing fat calories assists with weight reduction and heart wellbeing, search for an application that separates the immersed, unsaturated and trans fats in like manner nourishments. Some applications additionally monitor most basic supplements, from vitamin C to calcium. 

Numerous applications have worked in inspiration. You may need a day by day eating regimen tip to remain on track or a computerized journal to record and keep a running aggregate of calories eaten each day. There are even applications for following extraordinary weight control plans, such as following carbs and glucose for those with diabetes, applications with low-calorie formulas, and applications that let you filter bundled nourishments at the market to get moment criticism on whether they're beneficial for you. 

Since numerous applications are free, have a great time testing until the point when you locate the one you like best. One alert: Even the best application can't physically prevent you from eating, so think of it as only one section, however supportive, of your arrangement to get more fit.

Thursday, 26 October 2017

Nutrition, Children and the School Environment


Today’s children are in remarkably poor shape. Overweight and obesity is now the fifth leading global mortality risk (WHO, 2013 Obesity and overweight: Factsheet 311) http:// www.who.int/mediacentre/) and there has been a marked increase over the period in childhood obesity worldwide. The UK Government document ‘Healthy Lives, Healthy People: a call to action on obesity in England’ Department of Health 2011) expresses an aim to achieve a sustained downward excess weight gain in children by 2020. The jury is still out on the likelihood of this worthy ambition being realised. Obese children are likely to become obese adults with attendant chronic illnesses such as diabetes and heart disease presenting at earlier ages. 

An eight year study of over half a million children in the UK reported a marked use in insulin amongst the 12-18 age sector suggesting a rise in the prevalence and incidence of diabetes. (Hsia Y et al 2009: An increase in the prevalence of type 1 and 2 diabetes in children and adolescence: results from prescription data from a UK general practice database. Br J Clin Parmacol 67(2):242-9). The rise in chronic disease brings in its wake, increased financial pressure upon health services. A UK National Diet and Nutrition Survey further reveals that children are being badly served by their diets (Bates B et al 2014 National Diet and Nutrition Survey Results from Years 1, 2 3 and 4 (combined) of the Rolling Programme 2008/09 – 2011/012. public Health.

These outcomes are largely preventable and schools have a key role to play in the nutrient content of children’s daily diet. The food that children consume there from day one can influence their mental and physical health for the better both now and later in the life span and play a significant part in reducing the onset of future chronic disease and reducing the obesity burden. Studies are emerging to support these arguments, whether supplied by Public Health England (The link between pupil health and wellbeing and attainment. A briefing for head teachers, governors and staff in education settings. https://www.gov.uk/government/publications/the-link-between-pupil-health-and-wellbeing-and-attainment-(2014) or academic sources such as a 2012 study (Eating Breakfast enhances the efficiency of neural networks engaged during mental arithmetic in school-aged children. Physiol behave 016(4):548-55 Pivik RT et al) demonstrating that breakfast consumption boosted the efficiency of school children’s brain nerve networks when they were engaged with mental arithmetic, as compared with children who had not eaten breakfast.

Wednesday, 25 October 2017

Does Time of Neurosurgery Matter?


Patients who have neurosurgery overnight will probably have entanglements than those whose operations happen amid the day, another investigation finds. Danger of difficulties was 50 percent higher when surgeries started between 9 p.m. what's more, 7 a.m., said University of Michigan analysts. They looked into more than 15,800 neurosurgical techniques and their results. When representing the length of the surgery, the examination group found the chances of a complexity dramatically increased. 

Patients in the investigation experienced neurosurgery in the University of Michigan Health System in the vicinity of 2007 and 2014. There were 785 intricacies, including gentle pharmaceutical responses, diseases, heart assault and passing. Inconveniences turned out to be more typical twilight, yet not really more extreme aside from on account of crisis surgeries, the analysts said. 

They noticed that as it got later in the day, the level of elective cases fell while crisis cases expanded. It's conceivable that inconveniences turn out to be more probable since patients worked on overnight are more ailing, as indicated by the specialists. "We have to keep on studying this relationship [between night-time surgery and expanded danger of complications] as we plan to limit surgery-related complexities," said consider lead creator Dr. Aditya Pandey. He is a partner teacher of neurological surgery at the college. 

Pandey said the discoveries bring up major issues: Do wellbeing frameworks need to contribute more to permit a more noteworthy extent of surgeries amid day hours? Should pressing cases be balanced out and worked on amid the daytime? "These are essential inquiries that must be raised as we keep on solidifying the connection between surgical begin time and surgical entanglements," Pandey said in a diary news discharge. Past research has discovered higher confusion rates for off-hour surgeries in other wellbeing fields from orthopedics to heart mind, the scientists said in foundation notes.

Tuesday, 24 October 2017

Nanoparticles as Pharmaceutical Agents

Nanoparticles are advanced pharmaceutical agents. Nanoparticles add an emerging new technologies for pharmaceutical science. They developed customized solutions for drug delivery. Nanoparticles positively impact the rate of absorption, distribution, metabolism, and excretion (ADME) of the drug in the body. The optimum nanomaterial should be compatible, easy to bind with the target drug, and able to metabolized or driven out the body via normal excretory routes. Material-based technologies in the area of drug delivery include inorganic nanoparticles, metal organic frameworks (MOFs), solid lipid nanoparticles, liposomes, polysaccharides, polyesters, micelles, etc. These nanoparticles are applied for different therapy include chemotherapy, gene and vaccine delivery. Nanomaterials solve most of the limitations of traditional drugs such as solubility. They advances the drug delivery and offers excellent controlled drug delivery systems (DDS). So far, there are more than 51 FDA-approved nanomedicines and 77 products in clinical trials.

There are several drawbacks that limit the nanoparticles to serve as pharmaceutical agents. First, nanoparticles suffer from the intrinsic cytotoxicity. Thus, a few number of nanoparticles can work as biocompatible system for drug delivery. Second, the drug’s efficiency requires further improvements such as selectivity. The selectivity of conventional drug can be increased by surface engineering of the nanoparticles. The large surface area of nanoparticles enable surface modification with targeting biomolecules that can reach the infected cells. Third, nanoparticles suffer from the body sequestration. The nanoparticles with small size are highly preferred. Fourth, the inorganic based nanoparticles are not degradable compared to the organic based nanoparticles such as solid lipid nanoparticles, liposomes, polysaccharides, polyesters, micelles, etc.  

Friday, 20 October 2017

Even a Little Walking Can Lengthen Your Life


That night walk you take after supper most evenings might do you more great than you understand - new research proposes even a touch of standard strolling can decrease your danger of death. "Strolling has been depicted as the 'ideal exercise' since it is straightforward, free, helpful, doesn't require any exceptional hardware or preparing, and should be possible at any age," said consider pioneer Alpa Patel, a tumor disease transmission specialist from the American Cancer Society. "With the close multiplying of grown-ups matured 65 and more seasoned expected by 2030, clinicians ought to urge patients to walk regardless of the possibility that not exactly the prescribed sum, particularly as they age, for wellbeing and life span," Patel said in a general public news discharge. 

Past research has connected standard strolling with a lower danger of coronary illness, diabetes,and bosom and colon growths. In any case, numerous American grown-ups don't get the prescribed levels of strolling or different sorts of activity. The suggested sums are no less than 150 minutes of direct or 75 minutes of energetic physical movement seven days. In this investigation, scientists analyzed information from about 140,000 American grown-ups. Of those, 95 percent said they did some strolling. Almost half said strolling was their exclusive type of direct enthusiastic physical action. The scientists balanced the information to represent different variables that could influence the danger of death, for example, smoking,obesity and incessant medical issues. 

After those alterations, the scientists inferred that individuals whose lone exercise was strolling under two hours for every week had a lower danger of death from any reason than the individuals who did no physical action. The individuals who did one to two times the base measure of suggested week after week work out (2.5 to 5 hours) by just strolling had a 20 percent bring down danger of death. The danger of death was comparable among the individuals who surpassed action suggestions through just strolling. Strolling was most emphatically connected with decreased danger of death from respiratory maladies - around a 35 percent bring down hazard for the individuals who strolled over six hours every week than the individuals who were minimum dynamic. Strolling was likewise connected with around 20 percent bring down danger of death from coronary illness. Individuals who just strolled likewise had a 9 percent bring down danger of death from malignancy, the examination creators said.

Wednesday, 18 October 2017

Terlipressin Abuse:An Occult Killer for Patients with Critical Condition


Terlipressin is a vessel V2 receptor blocker, which has been the world widely used to better stop severe upper gastrointestinal tract bleeding, resulting from portal hypertension in cirrhosis. Nowadays Terlipressin is applied for other diseases including hepato-renal syndrome (Mattos et al., 2015), shock (Michel et al., 2016), ascites, and even with prevention of little-liver syndrome… etc., according to the most updated clinical guideline of Terlipressin. However, based on authors’ previous practice and evidence of the latest report of Šíma and colleagues study, it is more likely to lead to severe hyponatremia, and hypertension due to its adverse effects, which is difficult to control and then ultimately push patients with severe illness into potential risks of fatal consequence such as spontaneous cerebral hemorrhage or worsening of kidney failure or complexing the general conditions of patients during therapeutic course.

Now it is the time to remind physicians to focus on the pressing issue and to keep minds of raising their awareness of Terlipressin adverse effects. Foremost, multiple disciplinary teams (MDT) should outline the indication of Terlipressin before using it. Secondary, the hospital will keep an open eye on adverse effects of Terlipressin to ensure the safety of patients with severe illness. The authorities should enhance supervision guarding against excessive Terlipressin use or misuse. Therefore, it is the time to speed up the establishment procedures to make sure that all phases of Terlipressin use are traceable and the misuse of Terlipressin will be severely punished. Sample tests amid the severe patients should be a groundwork at an uncertain time to improve surveillance risk of Terlipressin. Strict indication for Terlipressin and measures will be taken to pro legal interests of patients. The violator will be put on a blacklist that will be punished at regular, and the physicians’ participations will be limited in the future. 

Terlipressin doctors all tend to take for granted, but it really has to wise up to the fact that right drug in right time is crucial, helping to protect the patients from unexpected damage as well as life threatening. Finally, the root cause for misusing of Terlipressin is that physicians themselves who may chase gray income or are a lack of knowledge about Terlipressin. For example, if the patients with cirrhosis, which is ongoing hepatic bleeding and infectious shock, Terlipressin should be forbidden according to authors’ experience, otherwise, it may induce cerebral stroke mainly due to blood-clot dysfunction and hypertension. If the kidney failure is resulting from hypotension or infection but not a hepato-renal syndrome, Terlipressin is not suitable for use. In conclusion, Terlipressin should be strictly administered, to protect patients’ safety. Everyone should get to know the latest guidance of Terlipressin and its cautious notes of using it.

Monday, 16 October 2017

Black Women Face Double the Risk of Pregnancy-Related Heart Failure


Dark American ladies are twice as likely as ladies in other racial/ethnic gatherings to build up a type of pregnancy-related heart failure,a new examination finds. Peripartum cardiomyopathy (PPCM) is a possibly perilous condition that can happen in the most recent month of pregnancy or up to five months following conveyance. With this issue the heart chambers amplify and heart muscle debilitates, prompting diminished blood stream that influences the lungs, liver and different organs. 

Scientists examined the restorative records of 220 ladies determined to have PPCM. Dark ladies with PPCM were more youthful (age 27 versus 31), had more serious sickness, and took more time to recoup than white, Hispanic or Asian ladies. 

"Not exclusively are African-American ladies at double the hazard, however in this investigation we discovered they likewise took twice as long to recuperate, they were twice as prone to intensify before showing signs of improvement after conclusion, and they were twice as liable to neglect to recoup by and large, which means their heart disappointment endured for a considerable length of time following conveyance," said senior creator Dr. Zoltan Arany in a University of Pennsylvania news discharge. He is a partner educator of cardiovascular solution and executive of the college's Cardiovascular Metabolism Program. 

The investigation "opens the entryway for much more research regarding this matter, to discover why these ladies are more in danger," consider creator Dr. Jennifer Lewey said. She's a collaborator educator of cardiovascular pharmaceutical and executive of the Penn Women's Cardiovascular Center. The analysts don't know why these distinctions happen. Lewey proposed the expanded hazard may be because of hereditary qualities, financial status or access to mind. Or, on the other hand it could be because of medicinal issues, for example, hypertension.

Monday, 9 October 2017

Surviving Congenital Heart Disease as Child Not a Ticket to Good Health


Despite the fact that the greater part of youngsters with inborn coronary illness get by into adulthood, they frequently battle with various long lasting ailments, specialists report. The medical problems may incorporate neurodevelopment issue, for example, a mental imbalance respiratory issues, as well as heart arrhythmias. 
"We are awesome at settling the pipes, yet not at settling the patient," said examine creator Martina Brueckner, a teacher of pediatrics and hereditary qualities at the Yale School of Medicine. Brueckner and her group called attention to that intrinsic coronary illness influences approximately 1 percent of babies. Around 90 percent will make it into adulthood. 
In any case, another hereditary examination that included about 2,900 inborn coronary illness survivors and their relatives uncovered that being conceived with that particular condition gives off an impression of being related with a higher hazard for creating other significant medical issues. Numerous qualities effectively involved in a mental imbalance were likewise connected with innate coronary illness, and the researchers additionally discovered new qualities that were connected to intrinsic coronary illness in a few patients. 
Be that as it may, the examination did not demonstrate that heart surrenders during childbirth caused these different diseases, it just demonstrated an affiliation.

Thursday, 5 October 2017

Surviving Heart Attack Often Means Leaving Job Behind


Recuperating from a heart assault can be a long, difficult process, and now another examination finds that right around one-fourth of those patients who came back to work at last left their employments over the next year. The discoveries recommend that "despite the fact that patients come back to work after a heart assault, they may in any case require singular modifications at their working environments with a specific end goal to remain utilized," said think about creator Dr. Laerke Smedegaard Petersen. She is a graduate understudy at Copenhagen University Hospital in Denmark. 

An expected 676,000 individuals in the United States survive heart assaults every year, as indicated by the American Heart Association. Numerous survivors are of working age: The normal time of heart assault is 65 for men and 72 for ladies, the affiliation says. The new investigation analyzed the therapeutic and work records of more than 22,000 patients in Denmark who were utilized before anguish heart assaults in the vicinity of 1997 and 2012. 

Of those, 91 percent came back to work inside a year. Be that as it may, inside a time of backpedaling to work, 24 percent of the patients had left their employments. That is three times the ordinary rate of leaving a vocation, the specialists detailed. It's not clear, be that as it may, regardless of whether the heart assault survivors quit their employments, or were terminated or laid off. Patients matured 30 to 39 and 60 to 65, and the individuals who had heart disappointment, diabetes or misery, were particularly liable to leave their employments. Specialists with higher salaries and more training will probably remain at work, the discoveries appeared. 

Petersen said the level of heart assault patients who come back to work and after that leave their employments might be much higher in the United States. "In Denmark, all residents have measure up to access to social insurance and all patients get treatment for nothing out of pocket," she clarified.

Wednesday, 4 October 2017

Perturbing Transsulfuration Pathway and Sulfur Recycling, A New Direction Towards Therapeutic Intervention of Inflammatory Bowel Disease

Combating inflammatory bowel disease (IBD) is becoming a growing challenge to the global health management. Our bowel can be envisioned as a big vessel reactor where millions of reactions occur at each moment, every day to meet the physiological demand of our body for quality control of our life. This includes the orchestration of several steps which ultimately funnel down to the intestinal system to drives the end point of the digestion process. Intestinal sulfur recycling by transsulfuration pathway can modulates the integrity of our bowel symptoms. Limiting the sulfur amino acid metabolism and mitigating hydrogen sulfide (H2S) generation can help to stabilize the colonic biochemistry with monitoring of metabolites for subsequent health risk assessment. Regulating protein sulfhydration in colonic tissue could play detrimental roles in the modulation of several contributing factors related to IBD.

Our bowel is challenged daily with a load of foods, primarily sourced from the environment. Many food components contain sulfides, polysulfide compounds, which ultimately breakdown to generate gaseous H2 S in situ. Hydrogen sulfide can interact with metabolic cytochrome c oxidase and carbonic anhydrase, by chelating with metalbinding porphyrin cofactor. Evolutionarily, H2 S has been viewed as an important prebiotic element. In nature, H2 S concentration increases in the deep ocean, oceanic volcanoes and mountain spring while the oxygen concentration decreases. Importantly, hydrogen sulfide can bypass the cellular oxygen demand and modulate energy production.

There are many micro bacteria that can produce H2 S. Some of these bacteria exist in the gut mucosal system of our gastrointestinal tract [8, 9]. Examples of these bacteria include sulfate reducing bacteria (SRB), thiobacillus, desulfobacter among others. Some of this microbiota could play a potent role during GI infection and inflammation, and thus could be one of the leading causes of IBD. Therefore, H2 S producing colonic microbiota in the GI tract can also modulate the mucosal immune system, and the IBD state, by producing H2 S or sulfur metabolites.

Tuesday, 3 October 2017

Predictors of Mortality of Primary Intracerebral Hemorrhage among the Sea Coast Population of South India

Intracerebral hemorrhage (ICH) is the second most leading cause for stroke, followed by ischemic stroke, which leads to high rates of mortality and morbidity. Worldwide statistics reveal the incidence of ICH is nearly up to 10-15% of all strokes and its incidence vary from region to region globally. In Asian population ICH ranges from 4 to 14% of all strokes when compared to the west. Despite advances in medical and neurosurgical treatment modalities, prognosis of ICH carries poor outcome, with high rates of mortality projected worldwide up to 40% to 50%. Identification of major governing factors for outcome of ICH is essential and also important in analyzing the population.

vessels. The secondary ICH arises mostly due to vascular malformations, coagulopathies, vasculitis, head injury, tumors, drug induced effects and drug abuse. PICH occurs in the brain commonly in the region of putamen, thalamus, cortical followed by cerebellar and brain stem. However the majority of primary ICH will be seen in elderly people whereas the secondary ICH is common in the Young age group. In the elderly population cerebral amyloid angiopathy (CAA) was found to be the significant cause for the lobar ICH. Earlier studies also revealed various etiologies for intracerebral hemorrhage which include chronic arterial hypertension, consumption of alcohol, treatment with anti-coagulants and antiplatelets, therapies related to thrombolytics, amphetamines usage, cocaine abuse, and usage of statins. 

In India, HTN is a burning health problem. Nearly 20% of the population under 50 years is suffering with HTN. Several studies clearly stated that HTN is the most common independent risk factor for PICH [8]. The incidence of ICH varies in various regions of India. For instance, a study conducted in Kolkata revealed that majority of stroke cases had PICH, which was higher when compared to the western world. In another study conducted in northeastern parts of India it was found that tribals had more PICH. Studies related to south India population identified that ICH constitutes up to 12% of all the strokes. Moreover, very few studies on PICH demonstrated its impact and outcome. Since India represents its vastness and heterogeneity in population, systematic studies from different regions of the country are needed. So far most studies revealed the outcome of PICH in urban population, but very few studies have been done to show the incidence and impact of PICH along the sea coast population.