High sensitivity C-reactive protein levels across spectrum and severity of coronary artery disease

Background: C-reactive protein (CRP) is an acute-phase reactant protein synthesized by the liver in response to acute\ud stress in a wide range of acute and chronic inflammatory conditions. In healthy subjects and patients presenting with\ud coronary artery disease (CAD), elevated levels of CRP has repeatedly been demonstrated to predict future cardiovascular\ud events.\ud Methods: We measured high sensitivity C-reactive protein (hs-CRP) levels in 382 consecutive patients with CAD and 60 healthy controls by immunoturbidimetry method. Risk factors like hypertension, diabetes mellitus, dyslipidaemia,smoking, obesity and family history of premature CAD were assessed.\ud Results: The mean age of patients with CAD was 53.5±11.8 years (303 males) and that of control group was 50.83±8.07(28 males). The patient group had significant higher concentration of mean hs-CRP levels when compared\ud with the healthy control group (1.8±1.9 mg/L vs 0.35±1.1 mg/L, p<0.001). The mean hs-CRP levels of unstable angina\ud (USA) and myocardial infarction (MI) patients was higher than chronic stable angina (CSA) patients (p<0.05). Based\ud on the disease severity, we found a significantly higher hs-CRP levels in patients of triple vessel disease when compared\ud to patients with single vessel disease (p=0.01).\ud Conclusions: Elevated serum hs-CRP levels provide a useful marker for cardiovascular risk which, when combined\ud with traditional risk factors, may help improve global risk prediction. Our study showed a significant contribution of\ud hs-CRP to coronary risk prediction with better discrimination

Prevalence, practice, and determinants of self-medication among the common public in a village of Northern Kerala, India

Background: Self-medication, managing health issues without professional guidance, poses significant risks to individuals and public health. Prevalence rates vary globally, often higher in low-income countries due to limited healthcare access. While self-medication offers cost-effective solutions for minor ailments, it may lead to misuse, adverse effects and financial burdens. Identifying factors driving self-medication is crucial for tailored interventions. This study aims to assess self-medication prevalence, practice, and influencing factors in a Kerala village. Methods: A community-based cross-sectional study included 212 participants (≥18 years) selected via convenient sampling. A pre-tested questionnaire collected socio-demographic data, self-medication prevalence, and influencing factors. Self-medication was defined as OTC drug use without consulting a medical graduate. Data were analyzed using SPSS 26, with chi-square tests for bivariate analysis (p≤0.05). Results: Participants (mean age: 38.13±15.56) reported 53.8% self-medication. Acute illness individuals self-medicated more (80.7% purchased from independent pharmacies). Time constraints (24.5%) and expired prescriptions (42.1%) drove self-medication. Medication choice was influenced by cost (54.3%), brand reputation (21.1%), and both (24.6%), with pharmacist recommendations (36.0%) playing a role. Self-medication was common among ages 41-60 (64.3%) and those with lower education levels (77.8% primary, 70.5% middle). Acute illness individuals self-medicated more (66%) than chronic cases (34%). Conclusions: This rural Kerala study identifies a 53.8% self-medication rate, affected by age, education, and healthcare preferences. Targeted interventions are needed for ethical self-medication and improved healthcare practices

Platelet HIF-2α promotes thrombogenicity through PAI-1 synthesis and extracellular vesicle release

Oxygen-compromised environments, such as high altitude, are associated with platelet hyperactivity. Platelets confined within the relatively impervious core of an aggregate/thrombus have restricted access to oxygen, yet they continue to perform energy-intensive procoagulant activities that sustain the thrombus. Studying platelet signaling under hypoxia is, therefore, critical to our understanding of the mechanistic basis of thrombus stability. We report here that hypoxia-inducible factor (HIF)-2α is translated from pre-existing mRNA and stabilized against proteolytic degradation in enucleate platelets exposed to hypoxia. Hypoxic stress, too, stimulates platelets to synthesize plasminogen-activator inhibitor-1 (PAI-1) and shed extracellular vesicles, both of which potentially contribute to the prothrombotic phenotype associated with hypoxia. Stabilization of HIF-α by administering hypoxia-mimetics to mice accelerates thrombus formation in mesenteric arterioles. In agreement, platelets from patients with chronic obstructive pulmonary disease and high altitude residents exhibiting thrombogenic attributes have abundant expression of HIF-2α and PAI- 1. Thus, targeting platelet hypoxia signaling could be an effective anti-thrombotic strategy

Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease

<p>Abstract</p> <p>Background</p> <p>Cardiac syndrome X is an important therapeutic and diagnostic challenge to physician. Study of Csx patients may help to understand the pathophysiology of coronary microcirculation and to gain an insight on the management of these group patients.</p> <p>Methods</p> <p>We measured the flow mediated dilation of the brachial artery both endothelium dependent and independent vasodilatation by high resolution ultrasound in 30 cardiac syndrome X patients and matched with 30 healthy control subjects.</p> <p>Results</p> <p>Significantly decreased flow mediated dilatation was observed in patients when compared to control (9.42 ± 7.20 vs 21.11 ± 9.16 p < 0.01) but no significant difference was observed between groups in response to nitroglycerin (25.39 ± 6.82 vs 28.87 ± 8.69). Receiver operator characteristic analysis showed that value of < 11.11 had sensitivity of 80%, specificity 86.67%, positive predictive value 76.66%, negative predictive value 83.33%. In total, 46% of subjects had endothelial dysfunction and of them, CSX subjects had higher prevalence (76% vs 16% p < 0.01) than control subjects. Higher mean values of body mass index, systolic blood pressure and diastolic blood pressure was observed in subjects with FMD < 11.11 than > 11.11(p < 0.01). In logistic regression analysis, FMD was significantly associated with systolic blood pressure (Odds ratio 1.122 95% CI 1.053-1.196 p < 0.01) and body mass index (Odds 1.248 95%CI 0.995-1.56 p < 0.05).</p> <p>Conclusions</p> <p>The study suggests impairment of endothelial function in cardiac syndrome X patients. Increased Systolic blood pressure and body mass index may increase the risk of impairment of endothelial function in this group of patients.</p

Optimizing pesticide spray coverage using a novel web and smartphone tool, SnapCard

International audienceThe overuse of pesticides leads to contamination of water and food. Therefore, there is a need for tools and strategies to optimize pesticide application. Here we present SnapCard, a user-friendly and freely available decision support tool for farmers and agricultural consultants, available at snapcard.agric.wa.gov.au. SnapCard allows to predict, measure, and archive pesticide spray coverage quantified from water-sensitive spray cards. Variables include spray settings such as nozzle orifice size, sprayer speed, water carrier rate and adjuvant, and weather variables such as barometric pressure, relative humidity, temperature, and wind speed at ground level. We use separate regression models for four nozzles types. Our results showed that there are strong and positive correlations between water carrier rate and spray coverage for all four nozzle types. Moreover, sprayer speed is highly negatively correlated with obtained spray coverage. In addition, there is no consistent effect of either nozzle type or use of a particular adjuvant, across water carrier intervals. We conclude that varying combinations of spray settings and weather conditions caused marked ranges of spray coverages among the four nozzle types, thus highlighting the importance of selecting the right nozzle orifice size and type. We demonstrate that realistic scenarios of environmental conditions and spray settings can lead to predictions of very low spray coverage with at least one of the four nozzle types. We discuss how the novel and freely available smartphone app, SnapCard, can be used to optimize spray coverage, reduce spray drift, and minimize the risk of resistance development in target pest populations

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

HERPES ZOSTER: A CLINICAL STUDY IN 205 PATIENTS

Background: Even though herpes zoster is a common condition its incidence and pattern of occurrence in the era of HIV disease is significant. Aim: To analyze the incidence, pattern of occurrence and evolution of herpes zoster with special attention to provocative factors if any. Materials and Method s: This was an analytical study conducted for 2 years based on a preformed proforma containing preliminary information, a detailed clinical evaluation regarding the segment of involvement, morphology, pattern of lesions, complications, disseminations etc. and investigations to establish provocative factors if any. Results: Incidence of herpes zoster was mainly in the fourth and third decades of life. A definite history of chicken pox was present in only 63.4% cases. In the majority (70%) herpes zoster occurred spontaneously. In 30% cases, immunosuppression due to chemotherapy, malignancy, HIV infection, diabetes mellitus were observed. The commonest segment affected was thoracic (42.4%) followed by cranial (28.2%) and cervical (12.1%). Majority resolved in 7-14 days except immunosuppressed. 34.6% of the patients had complications such as secondary bacterial infection, post herpetic neuralgia, and motor weakness. Ten patients had HIV infection as a provocative factor. Conclusion: The results of incidence and clinical pattern of herpes zoster is almost parallel to the previous studies. Any factors of immunosuppression should be checked, especially HIV, particularly in disseminated and long-lasting cases