This study examined the frequency of metabolic syndrome and its components in 357 patients with ischemic stroke in Pakistan. The researchers found that metabolic syndrome was present in 46.2% of patients, with the three most common components being high waist circumference (34.5%), high fasting blood sugar (35.3%), and low HDL cholesterol (26.5-73.5%). Female patients accounted for 75.2% of those with metabolic syndrome. The results suggest metabolic syndrome is a frequent occurrence in patients with ischemic stroke and its components are strongly associated with increased risk of the condition.
This document provides recommendations for evaluating and managing erectile dysfunction (ED) in patients with cardiovascular disease (CVD). It finds that ED often precedes CVD by 2-3 years and is associated with increased CVD risk and mortality. It recommends assessing all men with ED for CVD risk factors and stratifying risk. High risk patients should undergo stress testing. Lifestyle changes like weight loss and exercise can improve ED. Aggressive treatment of hypertension, diabetes and hyperlipidemia may also benefit ED patients. Managing cardiovascular health should take priority over initiating ED treatment. Phosphodiesterase 5 inhibitors are first-line ED therapy for most patients with CVD. Testosterone should be measured in all ED patients and supplementation may help ED in some
This study examines the relationship between metabolic syndrome and neuroendocrine and autonomic function. It finds that men with metabolic syndrome have higher levels of cortisol metabolites and catecholamines in their urine, as well as higher heart rate and lower heart rate variability, compared to healthy controls. These differences suggest increased activity of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system in metabolic syndrome. Psychosocial factors explained part of these neuroendocrine differences. Many of the changes appeared reversible in those who no longer had metabolic syndrome. The study provides initial evidence that chronic stress may contribute to the development of metabolic syndrome.
Study of serum magnesium and fasting blood glucose in hypertensioniosrjce
A study was carried out to determine the fasting blood glucose and serum magnesium levels in
patients with hypertension. A total of 80 hypertensive patients were evaluated, of which, 58 were males and 22
were females. The mean ages of male and female hypertensive subjects were 48.06±6.53 and 50.83±7.62
respectively. Hypomagnesemia was observed in 61.25% subjects and raised fasting blood glucose was identified
in 55.1% of individuals. Therefore occurrence of low serum magnesium and raised blood sugar level in patients
with hypertension was observed
HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
HIGH SENSITIVE C-REACTIVE PROTEIN (hs-CRP) AND ITS CORRELATION WITH ANGIOGRAP...M A Hasnat
Association between the plasma hs-CRP levels and the severity of coronary
stenosis in subjects remains controversial. This cross sectional study was performed in the
Department of Cardiology, Dhaka Medical College during July 2008 to December 2009, to determine whether the concentrations of hs-CRP correlate with the coronary atherosclerotic disease assessed by coronary angiography.
This study aimed to determine if levels of high-sensitivity C-reactive protein (hs-CRP) correlate with the severity of coronary artery disease as assessed by coronary angiography. 90 patients undergoing coronary angiography were divided into three groups based on their hs-CRP levels. Significant positive correlations were found between hs-CRP levels and vessel score, stenosis score, and extent score, suggesting higher hs-CRP levels are associated with more extensive coronary artery disease. The results indicate hs-CRP levels may be predictive of the severity of coronary atherosclerosis.
Association of cardio metabolic risk factors, serum nitric oxide metabolite a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Marc Penn, MD, PhD, FACC - Trials and Tribulations of Assessing CVD Risk in ...Cleveland HeartLab, Inc.
This document discusses the importance of assessing cardiovascular risk through inflammatory markers in addition to traditional lipid markers. It provides evidence that atherosclerosis is driven by inflammation and markers like hsCRP and MPO can help identify patients at higher risk of events. The document also discusses how statins work through multiple anti-inflammatory pathways beyond just lowering lipids. A multimarker inflammation approach is presented as a way to better stratify risk and identify high-risk patients within populations that may otherwise appear low risk based on traditional metrics alone.
This document provides recommendations for evaluating and managing erectile dysfunction (ED) in patients with cardiovascular disease (CVD). It finds that ED often precedes CVD by 2-3 years and is associated with increased CVD risk and mortality. It recommends assessing all men with ED for CVD risk factors and stratifying risk. High risk patients should undergo stress testing. Lifestyle changes like weight loss and exercise can improve ED. Aggressive treatment of hypertension, diabetes and hyperlipidemia may also benefit ED patients. Managing cardiovascular health should take priority over initiating ED treatment. Phosphodiesterase 5 inhibitors are first-line ED therapy for most patients with CVD. Testosterone should be measured in all ED patients and supplementation may help ED in some
This study examines the relationship between metabolic syndrome and neuroendocrine and autonomic function. It finds that men with metabolic syndrome have higher levels of cortisol metabolites and catecholamines in their urine, as well as higher heart rate and lower heart rate variability, compared to healthy controls. These differences suggest increased activity of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system in metabolic syndrome. Psychosocial factors explained part of these neuroendocrine differences. Many of the changes appeared reversible in those who no longer had metabolic syndrome. The study provides initial evidence that chronic stress may contribute to the development of metabolic syndrome.
Study of serum magnesium and fasting blood glucose in hypertensioniosrjce
A study was carried out to determine the fasting blood glucose and serum magnesium levels in
patients with hypertension. A total of 80 hypertensive patients were evaluated, of which, 58 were males and 22
were females. The mean ages of male and female hypertensive subjects were 48.06±6.53 and 50.83±7.62
respectively. Hypomagnesemia was observed in 61.25% subjects and raised fasting blood glucose was identified
in 55.1% of individuals. Therefore occurrence of low serum magnesium and raised blood sugar level in patients
with hypertension was observed
HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
HIGH SENSITIVE C-REACTIVE PROTEIN (hs-CRP) AND ITS CORRELATION WITH ANGIOGRAP...M A Hasnat
Association between the plasma hs-CRP levels and the severity of coronary
stenosis in subjects remains controversial. This cross sectional study was performed in the
Department of Cardiology, Dhaka Medical College during July 2008 to December 2009, to determine whether the concentrations of hs-CRP correlate with the coronary atherosclerotic disease assessed by coronary angiography.
This study aimed to determine if levels of high-sensitivity C-reactive protein (hs-CRP) correlate with the severity of coronary artery disease as assessed by coronary angiography. 90 patients undergoing coronary angiography were divided into three groups based on their hs-CRP levels. Significant positive correlations were found between hs-CRP levels and vessel score, stenosis score, and extent score, suggesting higher hs-CRP levels are associated with more extensive coronary artery disease. The results indicate hs-CRP levels may be predictive of the severity of coronary atherosclerosis.
Association of cardio metabolic risk factors, serum nitric oxide metabolite a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Marc Penn, MD, PhD, FACC - Trials and Tribulations of Assessing CVD Risk in ...Cleveland HeartLab, Inc.
This document discusses the importance of assessing cardiovascular risk through inflammatory markers in addition to traditional lipid markers. It provides evidence that atherosclerosis is driven by inflammation and markers like hsCRP and MPO can help identify patients at higher risk of events. The document also discusses how statins work through multiple anti-inflammatory pathways beyond just lowering lipids. A multimarker inflammation approach is presented as a way to better stratify risk and identify high-risk patients within populations that may otherwise appear low risk based on traditional metrics alone.
Syndrome metabolique et maladies vasculaires s novosfa_angeiologie
This document summarizes a presentation on detecting preclinical atherosclerosis and evaluating cardiovascular risk. It discusses the metabolic syndrome and its association with future cardiovascular events. The summary is:
1) The presentation discusses preclinical atherosclerosis, metabolic syndrome, and their ability to predict future cardiovascular events over long-term follow-up of patients.
2) Metabolic syndrome was found to double the risk of cardiovascular events over 20 years of follow-up compared to healthy patients.
3) Preclinical atherosclerosis detected by carotid ultrasound also independently predicted cardiovascular outcomes, with higher rates of events in patients showing thickening of carotid arteries.
Abstract—Subclinical Hypothyroidism is a much more common disorder with a world-wide occurrence as compared to overt Hypothyroidism. Overt Hypothyroidism is associated with abnormalities of lipid metabolism, but the significance of dyslipidemia in subclinical hypothyroidism (SCH) remains controversial.
Aims: To compare the lipid profile between subclinical hypothyroid patients & healthy controls (age & sex matched) so as to determine any association between lipid profile & subclinical hypothyroidism.
Materials and Methods: In a case-control study, Thyroid stimulating hormone (TSH), free T3, free T4, anti thyroperoxidase (TPO) antibodies, total cholesterol, high density lipoprotein(HDL) cholesterol, low density lipoprotein (LDL) cholesterol, Very low density lipoprotein (VLDL) cholesterol, serum triglycerides were measured in 50 patients with subclinical hypothyroidism and 50 age- and sex-matched Euthyroid controls after an overnight fasting.
Results: Mean serum triglycerides (TG) and very low-density cholesterol (VLDL) were significantly higher in patients with SCH than controls (P < 0.05). No association was found between serum total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and SCH.
Conclusions: Dyslipidemia is more common in SCH compared to controls. High serum triglycerides and VLDL were observed in patients with SCH.
This document discusses metabolic syndrome, a cluster of risk factors that increases the risk of cardiovascular disease when associated with insulin resistance. It provides definitions of metabolic syndrome from several major health organizations, which include obesity, dyslipidemia, high blood pressure, and insulin resistance or diabetes as core components. The document emphasizes that regardless of debates around defining metabolic syndrome, patients with multiple risk factors have increased risk of heart disease and should be identified and treated early through preventive healthcare practices and lifestyle changes.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Fatty Acids and their role in Cardiometabolic HealthArindam Pande
This document discusses fatty acids and their role in cardiometabolic health. It summarizes that the conventional view of the diet-heart hypothesis, which links saturated fat and cholesterol to heart disease, may be an oversimplification. Different fatty acids, including saturated fatty acids found in dairy, can have varying metabolic effects. Replacing saturated fats with polyunsaturated fats may lower heart disease risk, but replacing them with carbohydrates does not. Ongoing research is exploring the cardiovascular impacts of omega-3 supplements and specific plant oils. In conclusion, the type of fat consumed is important for heart health, not just total fat intake, and dietary patterns rather than single nutrients should be the focus.
This study examined 273 patients admitted with acute coronary syndrome (ACS) to Sohag University Hospital in Egypt. The researchers found:
1) The overall prevalence of low high-density lipoprotein cholesterol (HDL-C) was 73.3% among the patients.
2) Patients with low HDL-C had higher rates of in-hospital mortality (12% vs 11%) and congestive heart failure (18% vs 5.5%) compared to those with satisfactory HDL-C.
3) Low HDL-C was more common in women and was associated with insignificantly higher in-hospital mortality and congestive heart failure in women, but not in men.
The document discusses the paradoxical relationship between obesity and mortality in patients with kidney disease undergoing dialysis. Several studies are reviewed that found higher BMI in dialysis patients was associated with lower risks of death and hospitalization, unlike the general population where obesity increases health risks. The studies accounted for various factors and found even extreme obesity was protective. Weight gain over time was also associated with reduced mortality risk. The reasons for this reverse epidemiology are unclear but proposed mechanisms include increased stores of nutrients and anti-inflammatory proteins in adipose tissue.
What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
Lung transplantation has become an established treatment for end-stage lung diseases such as cystic fibrosis (CF). According to the document, lung transplantation for CF has seen improved outcomes over time, with 1-year survival rates now over 97% and 3-year survival rates of 86% at one center. While lung transplantation can significantly extend life for patients with CF, it also carries risks such as infections, rejection, and complications from immunosuppression. Ongoing research continues to further improve outcomes for CF patients receiving lung transplants.
This study aimed to clarify the relationship between lipid profile, morbidity assessed by Killip classification, and 30-day mortality in patients with acute myocardial infarction (AMI). The study found that low-density lipoprotein cholesterol (LDL-C) and triglyceride levels were significantly lower in patients with higher Killip classification (more severe heart failure) and in those who died within 30 days compared to survivors. After adjusting for risk factors, LDL-C less than 62.5 mg/dL and triglycerides less than 110 mg/dL were identified as cutoff values associated with higher 30-day mortality. Patients with both low LDL-C and triglycerides and high Killip classification had a nearly 11-fold
This document summarizes Dr. Chenhua Yan's work establishing and utilizing a modified donor lymphocyte infusion (mDLI) approach for the treatment of relapse after haploidentical hematopoietic stem cell transplantation (HSCT) for hematologic malignancies. The mDLI approach uses G-CSF mobilized peripheral blood stem cells and immunosuppressive agents after infusion to reduce graft-versus-host disease while preserving graft-versus-leukemia effects. Studies showed mDLI improved response rates and survival compared to chemotherapy or standard DLI alone for relapsed disease. Risk-stratified mDLI based on minimal residual disease also reduced relapse rates after transplantation.
Donor Lymphocyte Infusion in Patients with Hematological Malignancies after T...spa718
1. Donor lymphocyte infusion (DLI) is an effective method for treating relapse after hematopoietic stem cell transplantation. Modified DLI (mDLI) using G-CSF mobilized peripheral blood and short-term immunosuppression can reduce acute GVHD rates while maintaining the graft-versus-leukemia effect.
2. Prophylactic mDLI can significantly decrease relapse rates and increase survival in patients with advanced acute leukemia after HLA-identical or haploidentical transplantation.
3. Risk-stratified mDLI based on minimal residual disease monitoring may further reduce relapse and improve outcomes by targeting high-risk MRD-positive patients.
Serum il17 and il6 levels in a sample of iraqi patients with rheumatoid arthr...Alexander Decker
This study examined serum levels of IL-17 and IL-6 in 50 Iraqi patients with rheumatoid arthritis and 30 healthy controls. Serum levels of both IL-17 and IL-6 were significantly higher in patients compared to controls. There was a strong, highly statistically significant correlation between serum IL-17 and IL-6 levels. The optimum cut-off values for differentiating patients from controls were a serum IL-17 level of ≥71.8 pg/ml and a serum IL-6 level of ≥8.1 pg/ml. This suggests IL-17 and IL-6 may help diagnose rheumatoid arthritis and identify potential treatment targets.
Clinical Profile of Acute Coronary Syndrome among Young AdultsPremier Publishers
Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight into the clinical profile among these patients will help in devising a preventive strategy, in order to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken. Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%. About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive strategy for primordial prevention of cardiovascular events among young adults. The study envisaged the male, urban preponderance towards these events.
The JUPITER trial was stopped early due to clear evidence of benefit from rosuvastatin treatment. The trial aimed to test whether rosuvastatin could reduce cardiovascular events in apparently healthy people with normal LDL cholesterol but high hsCRP. Over 17,000 participants were randomized to rosuvastatin 20mg or placebo. After almost 2 years, rosuvastatin showed a highly significant 44% reduction in the primary cardiovascular endpoint compared to placebo, demonstrating its benefit in primary prevention. This clear benefit led to the trial being stopped early.
LDL Cholesterol Target :“ Lower the Better ”Arindam Pande
Lowering LDL cholesterol provides significant cardiovascular benefits and reduces risk, even in those with low baseline LDL levels or who achieve very low LDL levels with treatment. While residual risk remains even with intensive statin therapy to lower LDL well below current target levels, risk continues to decrease as LDL is further lowered. The lower the achieved LDL level, the lower the long-term risk of major cardiovascular events and atherosclerotic progression.
- Intracardiac echocardiography (ICE) provides images of intracardiac structures to guide interventional cardiac procedures, as an alternative to transoesophageal echocardiography.
- ICE catheters like the AcuNav provide high resolution ultrasound images through a catheter inserted into the heart. This allows procedures to be done with clearer imaging, less fluoroscopy, and without the risks of general anesthesia.
- ICE provides good views of the heart from within the right atrium. Withdrawing the catheter inferiorly brings other structures like the atrial septum into view to help guide interventions like defect closures.
This cross sectional study was conducted at Department of Biochemistry, Govt. Medical College Srinagar Kashmir. A total of 120 Kashmiri Type 2 diabetic patients and 30 normal controls were randomly selected. Diabetic dyslipidaemia is characterized by raised triglycerides, low high density lipoprotein and raised low density lipoprotein. Determination of serum lipid levels in people with diabetes is considered a standard of care because detection and treatment of dyslipidaemia is one means of reducing cardiovascular disease risk. The lipid profiles and lipoprotein levels of 120 known diabetic patients were studied. Total cholesterol (TC), Triacylglycerol’s (TG) Low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) levels were assayed for each group using standard biochemical methods. Dyslipidaemia was defined using the national cholesterol education programme – adult treatment panel III (NCEP-AT III) criteria. BMI and waist and hip circumferences were measured.
This study examined the effects of metabolic syndrome and atherosclerotic risk factors on blood sugar control in 200 diabetic patients in Thailand. The results showed that patients with a higher number of metabolic syndrome components, such as hypertension, obesity, high triglycerides, and low HDL, had greater difficulty controlling their blood sugar. Younger patients and those who did not regularly attend the diabetic clinic were also more likely to have uncontrolled blood sugar. While atherosclerotic risk factors like smoking and family history were associated with worse control, the relationship was inconclusive due to the study's small sample size. In conclusion, metabolic syndrome components and younger age were linked to challenges with blood sugar management in diabetic patients.
The document summarizes a study on the prevalence of metabolic syndrome in patients with acute stroke in Yemen. The study found that:
1) The prevalence of metabolic syndrome in acute stroke patients was 39.5%, with males more affected than females.
2) Hypertension was the most common metabolic comorbidity in stroke patients with metabolic syndrome, while central obesity was the least common.
3) The authors conclude that metabolic syndrome is common in stroke patients, which could be explained by metabolic syndrome itself or other metabolic comorbidities often associated with it.
CholesLo shows clinical significance in
helping reduce plasma cholesterol and
homocysteine levels and therefore affects
favourably the risk of subsequent development
of cardiovascular disease. Furthermore, our
findings suggest that the dose required to cause
such improvements in plasma lipid profile is
safe enough to be considered for use in general
population.
Syndrome metabolique et maladies vasculaires s novosfa_angeiologie
This document summarizes a presentation on detecting preclinical atherosclerosis and evaluating cardiovascular risk. It discusses the metabolic syndrome and its association with future cardiovascular events. The summary is:
1) The presentation discusses preclinical atherosclerosis, metabolic syndrome, and their ability to predict future cardiovascular events over long-term follow-up of patients.
2) Metabolic syndrome was found to double the risk of cardiovascular events over 20 years of follow-up compared to healthy patients.
3) Preclinical atherosclerosis detected by carotid ultrasound also independently predicted cardiovascular outcomes, with higher rates of events in patients showing thickening of carotid arteries.
Abstract—Subclinical Hypothyroidism is a much more common disorder with a world-wide occurrence as compared to overt Hypothyroidism. Overt Hypothyroidism is associated with abnormalities of lipid metabolism, but the significance of dyslipidemia in subclinical hypothyroidism (SCH) remains controversial.
Aims: To compare the lipid profile between subclinical hypothyroid patients & healthy controls (age & sex matched) so as to determine any association between lipid profile & subclinical hypothyroidism.
Materials and Methods: In a case-control study, Thyroid stimulating hormone (TSH), free T3, free T4, anti thyroperoxidase (TPO) antibodies, total cholesterol, high density lipoprotein(HDL) cholesterol, low density lipoprotein (LDL) cholesterol, Very low density lipoprotein (VLDL) cholesterol, serum triglycerides were measured in 50 patients with subclinical hypothyroidism and 50 age- and sex-matched Euthyroid controls after an overnight fasting.
Results: Mean serum triglycerides (TG) and very low-density cholesterol (VLDL) were significantly higher in patients with SCH than controls (P < 0.05). No association was found between serum total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and SCH.
Conclusions: Dyslipidemia is more common in SCH compared to controls. High serum triglycerides and VLDL were observed in patients with SCH.
This document discusses metabolic syndrome, a cluster of risk factors that increases the risk of cardiovascular disease when associated with insulin resistance. It provides definitions of metabolic syndrome from several major health organizations, which include obesity, dyslipidemia, high blood pressure, and insulin resistance or diabetes as core components. The document emphasizes that regardless of debates around defining metabolic syndrome, patients with multiple risk factors have increased risk of heart disease and should be identified and treated early through preventive healthcare practices and lifestyle changes.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Fatty Acids and their role in Cardiometabolic HealthArindam Pande
This document discusses fatty acids and their role in cardiometabolic health. It summarizes that the conventional view of the diet-heart hypothesis, which links saturated fat and cholesterol to heart disease, may be an oversimplification. Different fatty acids, including saturated fatty acids found in dairy, can have varying metabolic effects. Replacing saturated fats with polyunsaturated fats may lower heart disease risk, but replacing them with carbohydrates does not. Ongoing research is exploring the cardiovascular impacts of omega-3 supplements and specific plant oils. In conclusion, the type of fat consumed is important for heart health, not just total fat intake, and dietary patterns rather than single nutrients should be the focus.
This study examined 273 patients admitted with acute coronary syndrome (ACS) to Sohag University Hospital in Egypt. The researchers found:
1) The overall prevalence of low high-density lipoprotein cholesterol (HDL-C) was 73.3% among the patients.
2) Patients with low HDL-C had higher rates of in-hospital mortality (12% vs 11%) and congestive heart failure (18% vs 5.5%) compared to those with satisfactory HDL-C.
3) Low HDL-C was more common in women and was associated with insignificantly higher in-hospital mortality and congestive heart failure in women, but not in men.
The document discusses the paradoxical relationship between obesity and mortality in patients with kidney disease undergoing dialysis. Several studies are reviewed that found higher BMI in dialysis patients was associated with lower risks of death and hospitalization, unlike the general population where obesity increases health risks. The studies accounted for various factors and found even extreme obesity was protective. Weight gain over time was also associated with reduced mortality risk. The reasons for this reverse epidemiology are unclear but proposed mechanisms include increased stores of nutrients and anti-inflammatory proteins in adipose tissue.
What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
Lung transplantation has become an established treatment for end-stage lung diseases such as cystic fibrosis (CF). According to the document, lung transplantation for CF has seen improved outcomes over time, with 1-year survival rates now over 97% and 3-year survival rates of 86% at one center. While lung transplantation can significantly extend life for patients with CF, it also carries risks such as infections, rejection, and complications from immunosuppression. Ongoing research continues to further improve outcomes for CF patients receiving lung transplants.
This study aimed to clarify the relationship between lipid profile, morbidity assessed by Killip classification, and 30-day mortality in patients with acute myocardial infarction (AMI). The study found that low-density lipoprotein cholesterol (LDL-C) and triglyceride levels were significantly lower in patients with higher Killip classification (more severe heart failure) and in those who died within 30 days compared to survivors. After adjusting for risk factors, LDL-C less than 62.5 mg/dL and triglycerides less than 110 mg/dL were identified as cutoff values associated with higher 30-day mortality. Patients with both low LDL-C and triglycerides and high Killip classification had a nearly 11-fold
This document summarizes Dr. Chenhua Yan's work establishing and utilizing a modified donor lymphocyte infusion (mDLI) approach for the treatment of relapse after haploidentical hematopoietic stem cell transplantation (HSCT) for hematologic malignancies. The mDLI approach uses G-CSF mobilized peripheral blood stem cells and immunosuppressive agents after infusion to reduce graft-versus-host disease while preserving graft-versus-leukemia effects. Studies showed mDLI improved response rates and survival compared to chemotherapy or standard DLI alone for relapsed disease. Risk-stratified mDLI based on minimal residual disease also reduced relapse rates after transplantation.
Donor Lymphocyte Infusion in Patients with Hematological Malignancies after T...spa718
1. Donor lymphocyte infusion (DLI) is an effective method for treating relapse after hematopoietic stem cell transplantation. Modified DLI (mDLI) using G-CSF mobilized peripheral blood and short-term immunosuppression can reduce acute GVHD rates while maintaining the graft-versus-leukemia effect.
2. Prophylactic mDLI can significantly decrease relapse rates and increase survival in patients with advanced acute leukemia after HLA-identical or haploidentical transplantation.
3. Risk-stratified mDLI based on minimal residual disease monitoring may further reduce relapse and improve outcomes by targeting high-risk MRD-positive patients.
Serum il17 and il6 levels in a sample of iraqi patients with rheumatoid arthr...Alexander Decker
This study examined serum levels of IL-17 and IL-6 in 50 Iraqi patients with rheumatoid arthritis and 30 healthy controls. Serum levels of both IL-17 and IL-6 were significantly higher in patients compared to controls. There was a strong, highly statistically significant correlation between serum IL-17 and IL-6 levels. The optimum cut-off values for differentiating patients from controls were a serum IL-17 level of ≥71.8 pg/ml and a serum IL-6 level of ≥8.1 pg/ml. This suggests IL-17 and IL-6 may help diagnose rheumatoid arthritis and identify potential treatment targets.
Clinical Profile of Acute Coronary Syndrome among Young AdultsPremier Publishers
Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight into the clinical profile among these patients will help in devising a preventive strategy, in order to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken. Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%. About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive strategy for primordial prevention of cardiovascular events among young adults. The study envisaged the male, urban preponderance towards these events.
The JUPITER trial was stopped early due to clear evidence of benefit from rosuvastatin treatment. The trial aimed to test whether rosuvastatin could reduce cardiovascular events in apparently healthy people with normal LDL cholesterol but high hsCRP. Over 17,000 participants were randomized to rosuvastatin 20mg or placebo. After almost 2 years, rosuvastatin showed a highly significant 44% reduction in the primary cardiovascular endpoint compared to placebo, demonstrating its benefit in primary prevention. This clear benefit led to the trial being stopped early.
LDL Cholesterol Target :“ Lower the Better ”Arindam Pande
Lowering LDL cholesterol provides significant cardiovascular benefits and reduces risk, even in those with low baseline LDL levels or who achieve very low LDL levels with treatment. While residual risk remains even with intensive statin therapy to lower LDL well below current target levels, risk continues to decrease as LDL is further lowered. The lower the achieved LDL level, the lower the long-term risk of major cardiovascular events and atherosclerotic progression.
- Intracardiac echocardiography (ICE) provides images of intracardiac structures to guide interventional cardiac procedures, as an alternative to transoesophageal echocardiography.
- ICE catheters like the AcuNav provide high resolution ultrasound images through a catheter inserted into the heart. This allows procedures to be done with clearer imaging, less fluoroscopy, and without the risks of general anesthesia.
- ICE provides good views of the heart from within the right atrium. Withdrawing the catheter inferiorly brings other structures like the atrial septum into view to help guide interventions like defect closures.
This cross sectional study was conducted at Department of Biochemistry, Govt. Medical College Srinagar Kashmir. A total of 120 Kashmiri Type 2 diabetic patients and 30 normal controls were randomly selected. Diabetic dyslipidaemia is characterized by raised triglycerides, low high density lipoprotein and raised low density lipoprotein. Determination of serum lipid levels in people with diabetes is considered a standard of care because detection and treatment of dyslipidaemia is one means of reducing cardiovascular disease risk. The lipid profiles and lipoprotein levels of 120 known diabetic patients were studied. Total cholesterol (TC), Triacylglycerol’s (TG) Low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) levels were assayed for each group using standard biochemical methods. Dyslipidaemia was defined using the national cholesterol education programme – adult treatment panel III (NCEP-AT III) criteria. BMI and waist and hip circumferences were measured.
This study examined the effects of metabolic syndrome and atherosclerotic risk factors on blood sugar control in 200 diabetic patients in Thailand. The results showed that patients with a higher number of metabolic syndrome components, such as hypertension, obesity, high triglycerides, and low HDL, had greater difficulty controlling their blood sugar. Younger patients and those who did not regularly attend the diabetic clinic were also more likely to have uncontrolled blood sugar. While atherosclerotic risk factors like smoking and family history were associated with worse control, the relationship was inconclusive due to the study's small sample size. In conclusion, metabolic syndrome components and younger age were linked to challenges with blood sugar management in diabetic patients.
The document summarizes a study on the prevalence of metabolic syndrome in patients with acute stroke in Yemen. The study found that:
1) The prevalence of metabolic syndrome in acute stroke patients was 39.5%, with males more affected than females.
2) Hypertension was the most common metabolic comorbidity in stroke patients with metabolic syndrome, while central obesity was the least common.
3) The authors conclude that metabolic syndrome is common in stroke patients, which could be explained by metabolic syndrome itself or other metabolic comorbidities often associated with it.
CholesLo shows clinical significance in
helping reduce plasma cholesterol and
homocysteine levels and therefore affects
favourably the risk of subsequent development
of cardiovascular disease. Furthermore, our
findings suggest that the dose required to cause
such improvements in plasma lipid profile is
safe enough to be considered for use in general
population.
The document summarizes a study that examined the prevalence of metabolic syndrome among 101 kinesiology majors at a predominantly Hispanic university in South Texas. Key findings include:
1) 10 subjects (8 males and 2 females) met the criteria for metabolic syndrome by exhibiting abnormal values in 3 or more of the 5 components measured.
2) On average, subjects' measurements were below the thresholds for metabolic syndrome, however some males exhibited elevated blood pressure readings.
3) There were some gender differences observed, with males more likely than females to exhibit large waists, high triglycerides, high blood glucose, and high blood pressure.
4) While the prevalence of metabolic syndrome was low in this group
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
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This study examined the association between visceral fat (VF) and subcutaneous fat (SCF) with cardiovascular risk factors in 101 Brazilian adults. VF was significantly associated with higher triglycerides, lower HDL cholesterol, higher total cholesterol, larger waist circumference, and higher blood pressure in both women and men. SCF was significantly associated with higher triglycerides, LDL cholesterol, total cholesterol, larger waist circumference, and higher blood pressure in women, and larger waist circumference and metabolic syndrome in men. The findings support the idea that there are gender differences in the correlations between ectopic fat deposition and cardiovascular risk factors.
This study examined the association between abdominal fat distribution and cardiovascular risk factors in 101 Brazilian adults. Ultrasound was used to measure visceral fat (VF) and subcutaneous fat (SCF). The key findings were:
1) VF was significantly associated with several risk factors in both men and women such as triglycerides, blood pressure, waist circumference, and cholesterol levels.
2) SCF showed significant associations with risk factors like triglycerides, cholesterol, and blood pressure in women. In men, SCF correlated with waist circumference and metabolic syndrome.
3) When adjusted for other factors, VF demonstrated stronger correlations with risk factors in men, while SCF correlated more strongly with
Cholesterol May be a Negative Whereas Triglycerides Positive Acute Phase Reac...asclepiuspdfs
Background: We tried to understand some undetermined missions of cholesterol and triglycerides (TG) in the plasma in patients with the sickle cell diseases (SCD). Methods: All patients with the SCD and age and gender-matched control cases were included into the study. Results: We studied 363 patients with the SCD (194 males) and 255 control cases (136 males), totally. Mean ages of the SCD patients were similar in males and females (31.1 vs. 31.0 years, respectively, P > 0.05). Although the body weight and body mass index (BMI) were significantly suppressed in the SCD patients (59.9 vs. 71.5 kg and 21.9 vs. 25.6 kg/m2, respectively, P = 0.000 for both), the body heights were similar in both groups (164.9 vs. 167.0 cm, P > 0.05). Parallel to the suppressed mean body weight and BMI, fasting plasma glucose (92.8 vs. 97.6 mg/dL, P = 0.005), total cholesterol (121.4 vs. 165.0 mg/dL, P = 0.000), low-density lipoproteins (70.4 vs. 102.4 mg/dL, P = 0.000), and high-density lipoproteins (26.0 vs. 39.6 mg/dL, P = 0.000) values were all suppressed in the SCD patients, significantly. Similarly, both systolic (115.2 vs. 122.6 mmHg, P = 0.000) and diastolic blood pressure (73.0 vs. 86.6 mmHg, P = 0.000) were also suppressed in them, significantly. Interestingly, only the plasma TG were increased in the SCD patients (129.4 vs. 117.3 mg/dL, P = 0.000), significantly. Similarly, mean alanine aminotransferase value was not suppressed in them, too (27.4 vs. 27.3 U/L, P > 0.05). Conclusion: Cholesterol may be a negative whereas TG positive acute phase reactants in the plasma.
CVD Egypt Clinical Diabetes Reprint Summer 2010Mahmoud IBRAHIM
This document summarizes a study on screening Egyptian patients for diabetes and cardiovascular risk factors. The study found:
- 22.9% of patients had diabetes, 30.7% had hypertension, 33.4% had dyslipidemia, and 43% were smokers.
- Cardiovascular risk factors were more prevalent in females (57.7%) and urban populations (72.2%).
- Obesity affected 29% of patients and was correlated with higher blood pressure. Family history of diabetes was associated with higher BMI, waist circumference, blood sugar, and triglycerides.
- The high prevalence of risk factors indicates a need for national prevention programs in Egypt targeting obesity, diabetes, hypertension
The HOPE-3 trial found that combining treatment with rosuvastatin, candesartan, and hydrochlorothiazide reduced the risk of cardiovascular events by 29% compared to placebo in a population at intermediate cardiovascular risk. The combination therapy lowered LDL cholesterol by 33.7 mg/dL and systolic blood pressure by 6.2 mmHg on average over 5.6 years. It reduced the risk of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to placebo, with numbers needed to treat of 72 and 63 to prevent an event in the primary outcomes. Subgroup analyses suggested greater benefit for those with higher baseline blood pressure.
High Density Lipoproteins May Actually be Some Negative Acute Phase Proteins ...JapaneseJournalofGas
Patients with plasma HDL values lower than 40 mg/dL were collected into the first group, and then age and gender matched patients with plasma HDL values of 40 mg/dL
High Density Lipoproteins May Actually be Some Negative Acute Phase Proteins ...JohnJulie1
Patients with plasma HDL values lower than 40 mg/dL were collected into the first group, and then age and gender matched patients with plasma HDL values of 40 mg/dL and greater were collected into the second group, and compared in between
Ueda2016 metabolic syndrome in different population,which one is appropriate ...ueda2015
Metabolic syndrome is a cluster of disorders including high blood pressure, high insulin levels, excess body weight, and abnormal cholesterol that increases the risk of diseases like diabetes and heart disease. There is wide variation in the reported prevalence of metabolic syndrome across populations and definitions, and questions remain about its applicability and predictive power equally in all groups. Key determinants include obesity, especially abdominal obesity, and insulin resistance, but genetic and lifestyle factors also contribute to risk.
This study assessed the prevalence of metabolic syndrome in men with normal and abnormal semen parameters. Of 526 men studied, 26.5% had metabolic syndrome, higher than the general population prevalence of 18%. However, the prevalence of metabolic syndrome was not significantly different between men with normal versus abnormal semen parameters. While obesity and metabolic syndrome may impact fertility in women, this study found metabolic syndrome did not appear to have a major effect on male fertility or semen parameters. Larger longitudinal studies are still needed to understand potential effects over time.
Nonalcoholic fatty liver disease and carotid atherosclerosis in childrenSHAPE Society
Presented by:
Lucia Pacifico, Vito Cantisani, Paolo Ricci, John F. Osborn, Elisa Schiavo, Caterina Anania, Eva Ferrara, Giuliano Dvisic, and Claudio Chiesa
The document discusses a study that compared cardiovascular risk factors between three ethnic groups in the Netherlands: white Dutch, Creole Surinamese, and Hindustani Surinamese. The study found higher prevalence of metabolic syndrome and cardiovascular disease in the Creole and Hindustani groups compared to white Dutch. Metabolic syndrome fully explained ethnic differences in cardiovascular disease for Creoles, but only partly explained differences for Hindustani. The study also found alarmingly high rates of undiagnosed diabetes in Hindustani ages 35-44 and less adequate blood pressure control in hypertensive Creoles.
The document discusses insulin-like growth factor I (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3), their roles in growth and metabolism, and emerging clinical applications of measuring their levels in serum. It covers background biochemistry, modern assay methods and reference ranges, and applications in conditions like cancer, heart disease, and growth hormone disorders like acromegaly and growth hormone deficiency.
1) A 46-year-old man with type 2 diabetes, hypertension, obesity, and dyslipidemia presented with erectile dysfunction. Laboratory tests confirmed metabolic syndrome and hypogonadism.
2) The patient meets criteria for metabolic syndrome according to NCEP-ATP III guidelines due to diabetes, hypertension, abdominal obesity, and low HDL. Hypogonadism was diagnosed based on low total testosterone, free testosterone, and bioavailable testosterone levels.
3) Guidelines recommend screening patients with diabetes and symptoms of hypogonadism for low testosterone. The patient should have been screened for erectile dysfunction due to his risk factors of diabetes and metabolic syndrome.
Thyroid metabolic hormones and its correlation with bmi and lipid profile in ...Alexander Decker
This study examined the relationship between thyroid hormones, body mass index (BMI), waist circumference (WC), and lipid profile in 56 healthy adults (28 males, 28 females) aged 30-60 years. The results showed that triglyceride levels were significantly higher in males than females, while triiodothyronine (T3) levels were significantly higher in females. In males, BMI and WC positively correlated with cholesterol and LDL, and WC positively correlated with cholesterol and LDL. TSH negatively correlated with T4. In females, BMI and WC positively correlated, and WC positively correlated with VLDL. TSH negatively correlated with VLDL. T3 positively correlated with BMI and WC in females
Similar to Frequency of metabolic syndrome and its’ various (20)
This study examined 162 patients with cirrhosis who underwent endoscopic variceal band ligation to treat esophageal varices. The study aimed to determine the frequency and risk factors associated with the development of secondary gastric varices after eradicating esophageal varices. The results found that secondary gastric varices developed in 38 patients (23.5%) after eradicating their esophageal varices. Factors associated with an increased risk of developing secondary gastric varices included having more advanced liver disease (based on Child-Pugh class), larger esophageal varices at initial presentation, requiring more sessions of band ligation to eradicate the esophageal varices, and already having gastric varices present at initial presentation.
Frequency of prediabetes and influence of various riskSamiullah Shaikh
This study aimed to determine the frequency of prediabetes and observe the influence of various risk factors on the development of prediabetes. The study found that 29.4% of subjects had prediabetes. Several risk factors were strongly correlated with prediabetes, including high BMI, family history of diabetes, history of gestational diabetes, history of delivering a high birth weight baby, low HDL cholesterol, and high triglycerides. The results suggest screening those with risk factors can help identify individuals at high risk of developing diabetes.
Frequency of cirrhotic cardiomyopathy in patientsSamiullah Shaikh
This study aimed to determine the frequency of cirrhotic cardiomyopathy in patients with liver cirrhosis. The study included 74 patients with liver cirrhosis. Various tests were performed including ECG, echocardiogram, and proBNP levels. Cirrhotic cardiomyopathy was diagnosed if abnormalities were found on tests. The results found cirrhotic cardiomyopathy present in 44.6% of patients. A strong relationship was seen between cardiomyopathy and severity of cirrhosis, prolonged QT interval, reduced ejection fraction, and elevated proBNP levels. The study concluded that cirrhotic cardiomyopathy was present in a sizable proportion of patients, and increased with later stages of cirrhosis.
Validation of three non invasive markers in assessing the severity of liver f...Samiullah Shaikh
This study aimed to compare three non-invasive markers (APRI, AST/ALT ratio, FIB-4) to liver biopsy for assessing liver fibrosis severity in hepatitis C patients. The study analyzed data from 158 hepatitis C patients who underwent liver biopsy and had their APRI, AST/ALT ratio, and FIB-4 calculated based on routine blood tests. Results found that APRI and FIB-4 were better than AST/ALT ratio at excluding or predicting advanced liver fibrosis, with APRI <1 excluding advanced fibrosis in 70% of patients and FIB-4 <1.45 in 74% of patients. APRI >1 predicted advanced fibrosis in 87% of patients and FIB-4 >1.
This study examined 158 hepatitis C patients to determine the frequency of liver fat (steatosis) and its relationship to fibrosis severity. The results showed:
1) Steatosis was present in 45% of patients and ranged from mild to severe.
2) A strong correlation was found between increasing steatosis severity and worsening fibrosis stage.
3) No significant relationships were found between steatosis and either patient age or BMI. This suggests steatosis may play a role in accelerating liver disease progression in hepatitis C.
This study investigated hypocalcemia in patients with acute gastroenteritis at Liaquat University Hospital in Hyderabad, Pakistan. The study included 66 patients with acute gastroenteritis and 66 healthy control subjects. The mean serum calcium level was significantly lower in patients with acute gastroenteritis (6.8455 ± 1.8266 mg/dL) compared to the control group (9.2167 ± 0.4534 mg/dL). Hypocalcemia was observed in 62 (94%) of gastroenteritis patients but only 13 (20%) of controls. The results demonstrate that low serum calcium is common in patients with acute gastroenteritis.
Frequency of hyponatraemia and its influence on liver cirrhosis related compl...Samiullah Shaikh
This study evaluated the frequency and impact of hyponatremia (sodium levels below 130 mEq/L) in 217 patients with liver cirrhosis and ascites. Hyponatremia was found in 26.7% of patients and was associated with more severe liver disease and ascites. Patients with hyponatremia also experienced more frequent hepatic encephalopathy and cirrhosis complications like hepatorenal syndrome and spontaneous bacterial peritonitis during their hospital stay compared to patients with normal sodium levels. The study concluded that hyponatremia is common in cirrhotic patients and negatively influences the development of cirrhosis complications.
This study compared serum copper and zinc levels in 100 patients with chronic hepatitis C and 50 healthy controls. Serum zinc levels were significantly lower in patients (mean 3.2357 μmol/L) than controls (mean 4.246 μmol/L). Serum copper levels were significantly higher in patients (mean 2.210 μmol/L) than controls (mean 2.073 μmol/L). The authors conclude that increased copper and decreased zinc in patients may contribute to hepatic injury caused by chronic hepatitis C.
This study evaluated 222 patients with decompensated cirrhosis of the liver to compare the accuracy of the original Child-Pugh score and a creatinine-modified Child-Pugh score in predicting short-term outcomes. The creatinine-modified score added points based on serum creatinine levels to the original score. The creatinine-modified score more accurately predicted the development of complications like encephalopathy and ascites. It also better predicted in-hospital mortality and length of stay compared to the original Child-Pugh score. The creatinine-modified score showed marginally better prognostic accuracy than the original score, suggesting inclusion of serum creatinine can improve the predictive ability of the Child-P
This study examined 24 patients with Wilson's disease who presented with hepatic and/or neurological manifestations. The average age was 11.8 years. Most common presentations were jaundice (29.2%) and movement disorders like Parkinsonism (29.3%). Laboratory findings found low serum ceruloplasmin in 79.2% and high urinary copper in 62.5%. Based on criteria involving Kayser-Fleischer rings and ceruloplasmin levels, 70.8% were diagnosed with Wilson's disease. The study concludes that Wilson's disease causes diverse clinical presentations and requires a high index of suspicion for diagnosis.
Validation of three non invasive markers in assessing the severity of liver f...Samiullah Shaikh
This study aimed to compare three non-invasive markers (APRI, AST/ALT ratio, FIB-4) to liver biopsy for assessing liver fibrosis severity in hepatitis C patients. The study analyzed data from 158 hepatitis C patients who underwent liver biopsy and had their APRI, AST/ALT ratio, and FIB-4 calculated based on routine blood tests. Results found that APRI and FIB-4 were better than AST/ALT ratio at excluding or predicting advanced liver fibrosis, with APRI <1 excluding advanced fibrosis in 70% of patients and FIB-4 <1.45 in 74% of patients. APRI >1 predicted advanced fibrosis in 87% of patients and FIB-4 >1.
This study aimed to compare clinical diagnoses of stroke localization to CT scan findings in 110 patients. Clinically, 80.9% were diagnosed with cerebral infarction and 19.1% with cerebral hemorrhage. CT scans confirmed infarction in 83% and hemorrhage in 47.6%. Left parietal/temporo parietal infarction was the most common clinical diagnosis (43 patients) and CT scans confirmed in 41 patients. Middle cerebral artery territory involvement was most frequent. The study concluded that clinical localization of stroke is not always accurate but CT scans help provide confident diagnoses and inform prognosis and treatment.
This study examined 158 hepatitis C patients to determine the frequency of liver fat (steatosis) and its relationship to fibrosis severity. The results showed:
1) Steatosis was present in 45% of patients and ranged from mild to severe.
2) A strong correlation was found between increasing steatosis severity and worsening fibrosis stage.
3) No significant relationships were found between steatosis and either patient age or BMI. This suggests steatosis may play a role in accelerating liver disease progression in hepatitis C.
This study evaluated 222 patients with decompensated cirrhosis of the liver to compare the accuracy of the original Child-Pugh score and a creatinine-modified Child-Pugh score in predicting short-term outcomes. The creatinine-modified score added points based on serum creatinine levels to the original score. The creatinine-modified score more accurately predicted the development of complications like hepatic encephalopathy and ascites. It also better predicted in-hospital mortality and length of stay compared to the original Child-Pugh score. The creatinine-modified score showed marginally better prognostic accuracy than the original score, suggesting inclusion of serum creatinine can improve the predictive ability of the Child-
This study investigated hypocalcemia in patients with acute gastroenteritis at Liaquat University Hospital in Hyderabad, Pakistan. The study included 66 patients with acute gastroenteritis and 66 healthy control subjects. The mean serum calcium level was significantly lower in patients with acute gastroenteritis (6.8455 ± 1.8266 mg/dL) compared to the control group (9.2167 ± 0.5534 mg/dL). Hypocalcemia was observed in 62 (94%) of gastroenteritis patients but only 13 (20%) of controls. The results indicate that low serum calcium is common in patients with acute gastroenteritis.
Frequency of hyponatraemia and its influence on liver cirrhosis related compl...Samiullah Shaikh
This study evaluated the frequency and impact of hyponatremia (sodium levels below 130 mEq/L) in 217 patients with liver cirrhosis and ascites. Hyponatremia was found in 26.7% of patients and was associated with more severe liver disease and ascites. Patients with hyponatremia also experienced more complications like hepatic encephalopathy. Even mild hyponatremia with sodium levels between 131-135 mEq/L increased the risk of cirrhosis complications compared to patients with normal sodium levels. The study concludes that hyponatremia is common in cirrhotic patients and negatively influences the development of cirrhosis complications.
This study analyzed the causes of stroke in 50 young patients aged 15-35 years at a tertiary hospital in Pakistan. The most common cause of stroke was infective meningitis (34%), primarily tuberculosis meningitis. The second most common cause was cardioembolism (20%), mainly due to valvular heart disease. Other major causes included hypertension (14%), pregnancy-related conditions (12%), and systemic lupus erythematosus (4%). Overall, infectious diseases were the leading cause of stroke in this young patient population.
This study aimed to compare serum zinc and copper levels in patients with chronic hepatitis C and healthy individuals. The researchers found:
1) Serum zinc levels were significantly lower in patients with chronic hepatitis C compared to healthy controls.
2) Serum copper levels were significantly higher in patients with chronic hepatitis C compared to healthy controls.
3) The increased copper levels in chronic hepatitis C patients may contribute to hepatic injury, while lower zinc levels indicate zinc deficiency which can impact liver function.
This study examined 24 patients with Wilson's disease who presented with hepatic and/or neurological manifestations. The average age was 11.8 years. Most common presentations were jaundice (29.2%) and movement disorders like Parkinsonism (29.3%). Laboratory findings found low serum ceruloplasmin (<20 g/l) in 79.2% of patients and high urinary copper excretion (>100 ug/24hrs) in 62.5% of patients. Based on clinical and laboratory criteria, the diagnosis of Wilson's disease was made in 70.8% of patients. The study concludes that Wilson's disease can present with diverse symptoms involving the liver or nervous system and requires a high index of suspicion for
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
2. 248 Int. J. Med. Med. Sci.
Table 1. Baseline characteristics of all patients (n=357).
Characteristic Value
Continuous variable Range Min-maximum
Age (years) 63 35-95
Categorical variable Frequency Percentage
Male 226 63.3
Female 131 36.7
Components of metabolic syndrome Male Female Male Female
Three 41/165 124/165 24.8 75.2
Systolic blood pressure >130 mmHG 65/165 100/165 39.39 60.60
Triglyceride levels >150 mg /dl 62/183 121/183 33.87 66.12
HDL levels < 50 mg/dl female and < 40 mg/dl in male 62/234 172/234 26.49 73.50
waist circumference >90 cm in male and >80 cm in female 123 34.45
FBS >100 mg/dl 126 35.29
FBS = fasting blood sugar; HDL= high density lipoprotein.
observe the frequency of metabolic syndrome and its’ HDL and LDL cholesterol levels. Glucose levels were measured by
various components in patients with ischemic stroke. enzymatic assay using an Eppendorf 5060 auto-analyzer.
Patients were diagnosed as metabolic syndrome on the basis of
ATPIII (Alberti, 2005) criteria which include presence of at least
MATERIALS AND METHODS three features: 1) blood pressure of at least 130/85 mmHg or trea-
ted hypertension, 2) serum triglyceride level of at least 150 mg/dl
This descriptive case study was conducted in Liaquat University (1.7 mmol/l), 3) HDL cholesterol of < 40 mg/dl (1.03 mmol/L) in men
Medical and Health Sciences hospital, Hyderabad, Pakistan from and < 50 mg/dl (1.29 mmol/L) in women, 4) fasting glucose of > 100
June, 2008 to November, 2009. This is a tertiary care hospital for mg/dl (5.6 mmol/l) or previously diagnosed with type 2 diabetes and
about 20 million urban, rural and multi-ethnic populations. The 5) central obesity, waist circumference greater than 90 cm in men
study included 357 consecutive patients of either sex presented and 80 cm in female according to Population- and country-specific
with ischemic stroke. The study was started after approval of the definitions (WHO Expert Consultation, 2004).
university ethical committee. Informed consent was taken from the
patients or their relatives. During the first visit, records were
Statistical procedure
obtained on the patient’s medical history. The conventional risk fac-
tors such as body weight, body mass index (BMI), blood pressure
measurement, history of smoking, a past history of stroke, family Continuous variables such as age was expressed as range with
history of stroke, use of antidiabetic, antihypertensive, and minimum and maximum. Categorical variables such as sex, pres-
antihyperlipidemic drugs were enrolled in well designed proforma. A ence or absence of metabolic syndrome, components of metabolic
complete physical examination was performed. Stroke was defined syndrome HDL levels > or < 50mg/dl in female and > or < 40 mg/dl
as a focal neurological disorder with rapid onset which persisted at in male, waist circumference > or < 90 cm in men and > or < 80 cm
least 24 h or until death and had a brain CT that showed a in women, triglyceride levels > or < 150 mg /dl, fasting glucose of >
compatible low-density lesion (Shimamoto et al., 1989). or < 100 mg/dl, blood pressure of at least 130/85 mmHg were
For each patient, blood pressure was taken after 15 min of rest. It expressed as percentage and frequency. The chi-square test was
was measured by a mercury sphygmomanometer with the subject applied to compare categorical variables such as metabolic syn-
seated comfortably with the arm supported and positioned at the drome, HDL levels, waist circumference, systolic blood pressure,
level of the heart. The final blood pressure estimate was the triglyceride levels and fasting blood sugar with the ischemic stroke.
average of three readings. Neither smoking nor caffeine was per- A p-value of 0.05 was considered as statistically significant. All
mitted before the blood pressure measurement. Individuals on calculations were done using SPSS version 16 (Chicago, IL, USA).
antihypertensive medications were considered as hypertension
patients regardless of blood pressure levels. Waist circumference
was measured by a trained examiner using a measuring tape RESULTS
positioned midway between the lowest rib and the iliac crest. All
study participants were individually interviewed by trained medical This study included 357 patients of which 131 (36.7%)
students with a structured questionnaire to obtain information on were male and 226 (63.3%) were female. The age of the
socio-demographic characteristics, physical activity and exercise patients ranged from 35 to 95 years. Table 1 shows the
habits (yes vs. no, defined by less than 20 min exercise per week), baseline characteristics of patients. The three compo-
smoking, and alcohol consumption. For baseline examination,
nents of metabolic syndrome was present in 165 (46.2%)
blood was drawn from patients into a plain, siliconized glass tube
and the serum was separated. Fasting serum samples were stored patients of which 41/165(24.8%) were male and 124/165
at -7° prior to the batch assay using standard enzymatic tests for
C (75.2%) were female (0.001). Systolic blood pressure g
cholesterol and triglyceride levels and precipitation methods for was present in 165 patients of which 65 were male and
3. Shaikh et al. 249
Table 2. Comparision of various categorical variables with ischemic stroke.
Variable Frequency Percentage P value
Three components of metabolic syndrome 165 46.2 0.001*
Gender 0.001*
Male 41 24.8
Female 124 75.2
HDL levels < 50mg/dl female and < 40 mg/dl in male 234 65.5 0.001*
Triglyceride levels >150 mg /dl 183 51.26 0.153
Systolic blood pressure >130mm Hg 165 46.21 0.001*
FBS > 100mg/dl 126 35.29 0.421
Waist circumference >90 cms in male and >80cms in female 123 34.45 0.001*
*P value < 0.05 is statistically significant . FBS = fasting blood sugar; HDL= high density lipoprotein.
100 were female (0.137). FBS > 100 mg/dl was present 23 times greater in female than male persons with
in 126 patients of which 57 had metabolic Syndrome metabolic syndrome. The Northern Manhattan study
(0.421).Triglyceride levels >150 mg/dl was present in183 which included Hispanic, African-American, and
cases of which 62 were male and 121 female (0.153). Caucasian subjects, reported an increased risk of stroke
Waist circumference greater than 90 cm in men and 80 among women with metabolic syndrome [hazard ratio
cm in female was present in 123 patients of which 90 had (HR=2.1)] compared to men (HR=0.9) (Rincon et al.,
other components of metabolic syndrome (0.001) HDL 2009). Koren and Morag (2005) similarly reported that
levels < 50mg/dl was present in172 female and >40 metabolic syndrome without diabetes mellitus was a
mg/dl in 62 male (0.001). Table 2 shows comparison of significant risk factor for ischemic stroke in both sexes,
different categorical variables with the ischemic stroke. but the effect was more pronounced in women [odds ratio
(OR=2. 10)] than in men (OR=1. 39). On the other hand,
Kurl et al. (2006) reported that the risk of ischemic stroke
DISCUSSION is significantly increased in men with metabolic syndrome
in Finland. The result of theirs might be due to the long
In this case study, metabolic syndrome was found in follow-up period (average follow-up of 14.3 years).
46.3% of patients, with ischemic stroke making a signifi- Dyslipidemia which is characterized by high
cant association. Our observation was supported by triglycerides and low HDL has always been considered
Gorter et al. (2004) who found metabolic syndrome in 40 as a hallmark of the MetSyn. Our data has shown strong
to 50% of patients with various cardiovascular diseases. association between dyslipidemia and ischemic stroke as
Metabolic syndrome was present in 56% of patients with triglyceride levels >150 mg /dl was present in183 cases
ischemic stroke in a study conducted by Koren and and HDL levels <50mg/dl was present in 172 female and
Morag (2005). De Silva (2007) recorded metabolic syn- >40 mg/dl in 62 male. According to Copenhagen City
drome in 61% of South Asian patients. In Third National Heart Study, a 47% reduction in ischemic stroke was
Health and Nutrition Examination survey of 15922 sub- found for 1.0 mmol/l (39 mg/dl) rise in HDL (Lindenstrom,
jects, metabolic syndrome was significantly associated 1994). Our study is also in consistence with Milionis et al.
with self reported stroke (odds ratio 2.2; 95% CI, 1.5 to (2005) which stated that high TG levels and low HDL-C
3.2) (National Institutes of Health , 2001). In Framingham levels had a relationship with ischemic stroke. The British
offspring study, metabolic syndrome was found more regional heart study, a prospective study consisting 7735
important risk factor for ischemic stroke as compared to men followed up for 16.8 years, also revealed a signifi-
diabetes mellitus (19 vs. 7%) (Najarian et al., 2006) .The cant association between HDL levels and stroke with a
Atherosclerosis Risk in Communities (ARIC) study also relative risk (RR) for nonfatal stroke was 0.59 (95% confi-
noted that patients with metabolic syndrome have higher dence interval, CI, 50.39 to 0.90; P50.03) (Wannamethee
risk of incident stroke (hazard ratio, 2.74 to 4.16 com- et al., 2000).
pared to the reference group) provided the metabolic In the Finnmark study, a 51.29% increase in stroke in
syndrome contains either high blood pressure or elevated women was seen for each 1.0 mm/l (88.5 mg/dl) increase
fasting blood sugar (Sol et al., 2009). In our study, meta- in TG levels (Njolstad et al., 1996). The Framingham
bolic syndrome was found in 75.2% female as compared study (Gordon et al., 1981) contradicts these results by
to 24.8% male. Takahashi et al. (2007) in their study observing that HDL had a non-significant effect on the
noted that the chances of developing ischemic stroke are development of ischemic stroke in either sex. The
4. 250 Int. J. Med. Med. Sci.
contradiction in results may be attributed to differences in Study: Stroke, 39:30-35.
De Silva DA, Fung PW, Xiao YX, Christopher LHC, Hui MC, Meng CW
sample size as in the Copenhagen study the number of (2007). Metabolic Syndrome Among Ethnic South Asian Patients
subjects studied were 11,342 vs. 2723 in the With Ischemic Stroke and Comparison With Ethnic Chinese Patients:
Framingham study. The Singapore General Hospital Experience: J. Stroke Cerebrovasc.
High blood pressure has emerged as an important Dis., 16(3): 119-121.
component in our patients as 165 patients had systolic Gorter PM, Olijhoek JK, van der GY (2004) Prevalence of the metabolic
syndrome in patients with coronary heart disease, cerebrovascular
blood pressure >130 mm of HG. In NOMAS study, a disease, peripheral arterial disease or abdominal aortic aneurysm.
linear relationship between blood pressure and risk of Atherosclerosis, 173: 363-369.
ischemic stroke and other vascular events such as fatal Gordon T, Kannel WB, Castelli WP, Dawber TR (1981) Lipoproteins,
cardiovascular disease and death: the Framingham study. Arch. Int.
or nonfatal hospitalized myocardial infarction, fatal CHD,
Med., 141: 1128-1131.
silent myocardial infarction was found with an increase in Howard BV. (1999). Insulin resistance and lipid metabolism. Am. J.
either event by 35% (Boden-Albala et al., 2008). McNeill Cardiol., 84: 28-32.
and Rosamond (2006) have found high blood pressure Isomma B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Groop L
(2001). Cardiovascular morbidity and mortality associated with the
as an important component of metabolic syndrome which metabolic syndrome. Diabetes Care, 24: 683-689.
increased the risk of ischemic stroke by 1.5 and 2 times Kazuo T, Hirokazu B, Shotai K, Kenichi I, Atsushi N, Shuhei Y (2007)
after adjustment for established risk factors. Metabolic Syndrome Increases the Risk of Ischemic Stroke in
Increased waist circumference which represents abdo- Women: internal medicine Tokyo Japan, 46(10): 643-648.
minal obesity has a strong association with stroke in our Kurl S, Laukkanen JA, Niskanen L (2006).Metabolic syndromeand the
risk of stroke in middle-aged men. Stroke, 37: 806-811
study as a waist circumference greater than 90 cm in Lindenstrom E, Boysen G, Nyboe J (1994) Influence of total cholesterol,
men and 80 cm in female was present in 123 patients. high-density lipoprotein cholesterol, and triglycerides on risk of
Isomma (2001) in study of 6,645 persons noticed obesity cerebrovascular disease: the Copenhagen City Heart Study. BMJ,
309: 11–15.
in 76% of men with normal glucose tolerance (NGT) and
Liu J, Grundy SM, Wang W, Smith SC Jr, Vega GL, Wu Z, Zeng Z,
92% of diabetic men with ischemic stroke.Helsinki Police- Wang W, Zhao D (2007) Ten-year risk of cardiovascular incidence
men Study has also shown a moderate association with related to diabetes, prediabetes, and the metabolic syndrome. Am.
HR (hazard ratios) 2.12 (1.28 to 3.49) between metabolic Heart J., 153: 552-558.
syndrome and stroke with special emphasis on obesity as Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ (2006)
Global and regional burden of disease and risk factors: systematic
a risk factor (Marja Pyörälä, 1998). Visceral fat which analysis of population health data. Lancet, 367: 1747–57.
constitutes abdominal obesity is postulated to release Marja P, Heikki M, Markku L, kalevi P (1998) Hyperinsulinemia and the
free fatty acids and increases the synthesis and secretion Risk of Stroke in Healthy Middle-Aged Men : The 22-Year Follow-Up
of very-low-density lipoproteins (VLDLs) (Tripathy et al., Results of the Helsinki Policemen Study Stroke, 29: 1860-1866.
McNeill A, Katz R, Girman C, Rosamond W, Wagenknecht L, Brazilay J,
2003). This increase release of FFA plays a pivotal role in Tracy R, Savage P, Jackson S (2006). Metabolic syndrome and
the pathogenesis of insulin resistance which is a hallmark cardiovascular disease in the elderly. The Cardiovascular
of metabolic syndrome (Howard et al., 1999). HealthStudy. J. Am. Geriatr. Soc., 54(9):1317-24.
Milionis HJ, Rizos E, Goudevenos J, Seferiadis K, Mikhailidis DP, Elisaf
There was a lack of association between glucose
MS (2005) Components of the metabolic syndrome and risk for
abnormality and the risk of stroke in our study. This could firstever acute ischemic nonembolic stroke in elderly subjects. Stroke
be due to inclusion of patients with mild to moderate 36:1372–6.
glucose abnormality in our study. Liu et al. (2007) has Koren-Morag N, Goldbourt U, Tanne D (2005) Relation between the
also shown in their study that glucose abnormality can Metabolic Syndrome and Ischemic Stroke or Transient Ischemic
AttackA Prospective Cohort Study in Patients with Atherosclerotic
only increase the risk of ischemic stroke by 14%. This Cardiovascular Disease. Stroke, 36: 1366-1371.
study has its limitations. The results of this study cannot National Institutes of Health (2001). Third Report of the National
be generalized to the population as this is not a case Cholesterol Education Program Expert Panel on Detection,
Evaluation and Treatment of High Blood Cholesterol in Adults (Adult
control study which requires the prevalence of metabolic
Treatment Panel III). Washington DC: US Government Printing
syndrome in the normal population in Pakistan. Office. NIH Publication No. 01-3670.
Metabolic syndrome is a frequent occurrence in Najarian RM, Lisa MS, William BK, Peter WFW, Ralph BDA, Philip AW
patients with ischemic stroke. It is not only metabolic syn- (2006). Metabolic Syndrome Compared With Type 2Diabetes Mellitus
as a Risk Factor for Stroke; The Framingham Offspring Study. Arch.
drome, but its individual components have emerged as
Int. Med., 166: 106-111
an important risk factor for ischemic stroke. Its early Ninomiya J, L’Italian G, Criqui M, Whyte J (2004) Association of the
diagnosis and treatment of patients at risk may avert the metabolic syndrome with a history of myocardial infarction and stroke
development of ischemic stroke. Caring physicians in the third National Health and Nutrition Examination Survey.
should look for metabolic syndrome and expect it in about Circulation, 109: 42–46.
Njolstad I, Arnesen E, Lund-Larsen PG (1996) Body height,
half of their patients. More studies are warranted. cardiovascular risk factors and risk of stroke in middle-aged men and
women. Circulation, 94: 2877–2882.
Park JH, Kwon HM, Roh JK (2007) Metabolic syndrome is more
REFERENCES associated with intracranial atherosclerosis than extracranial
atherosclerosis. Eur. J. Neurol., 4: 379-386.
Alberti KG, Zimmet P, Shaw J (2005) The metabolic syndrome— a new Reaven G, Banting L (1988). Role of insulin resistance in human
worldwide definition. Lancet, 366: 1059-1062. disease. Diabetes, 37: 1595-1607.
Boden-Albala B, Ralph LS, Hye-Sueng L, Cairistine GC, Tanja R (2008) Rincon F, Ralph LS, Grace K, Qiu X, Myungee C (2009). Incidence
Metabolic Syndrome and Ischemic Stroke Risk: Northern Manhattan and Risk Factors of Intracranial Atherosclerotic Stroke: The Northern
5. Shaikh et al. 251
Manhattan Stroke Study. Cerebrovasc. Dis., 28: 65-71 and impairs vascular reactivity in healthy subjects. Diabetes, 52: 2882–
Shimamoto T, Komachi Y, Inada H, Doi M, Iso H, Sato S (1989) Trends 2887.
for coronary heart disease and stroke and their risk factors in Japan. Wannamethee SG, Shaper G, Ebrahim S (2000). HDL-Cholesterol, total
Circulation, 79: 503–515. Cholesterol and the risk of stroke in middle-aged British men. Stroke,
Sol M, Rodriguez-Colon MS, Jingping M, Yinkang D, Jiahao L, Joanne 31: 1882–1892.
EC, Xuejuan J, Duanping L (2009) Metabolic Syndrome Clusters and WHO (2008). Burden of Disease Statistics. Geneva, Switzerland: World
the Risk of Incident Stroke The Atherosclerosis Risk in Communities Health Organization. http://www.who.int/healthin-fo/bod/en/index.
(ARIC) Study. Stroke, 40: 200-205. Html.
Strong K, Mathers C, Bonita R. (2007) Preventing stroke: saving lives WHO Expert Consultation (2004). Appropriate body-mass index for
around the world. Lancet Neurol., 6: 182-187. Asian populations and its implications for policy and intervention
Syed NA, Khealani BA, Ali S, Hasan A, Akhtar N, Brohi H (2003) strategies [published correction appears in Lancet. 2004; 363: 902].
Ischemic stroke subtypes in Pakistan: the Aga Khan University Lancet, 363: 157-163.
Stroke Data Bank. J. Pak. Med. Assoc., 53: 584-88.
Tripathy D, Mohanty P, Dhindsa S, Syed T, Ghanim H, Aljada A,
Dandona P (2003) Elevation of free fatty acids induces inflammation