Calcific aortic valve disease and hypertension

This review addresses the role of hypertension in precipitating Calcific aortic valve disease (CAVD) and the therapeutic potential of anti-hypertensive interventions to ameliorate CAVD. CAVD was originally considered to be a degenerative disease representing the "wear and tear" of the aortic valves. More recently both conceptually and experimentally, CAVD has come to be considered the result of an active disease process, Whilst, there are some common factors in the pathology and risk factors for atherosclerosis and CAVD there are also some distinct differences. Hypertension is an established risk factor for coronary artery disease and has been recognised as a risk factor for CAVD. Angiotensin converting enzyme inhibitors have been found to have beneficial effects in CAVD and as in atherosclerosis such effects may be due to the blood pressure lowering action but also to direct pleiotropic effects on the biochemical and cellular mechanisms of disease progression in the respective tissues. The very high prevalence of hypertension in the community coupled with an aging population, a risk factor associated with both hypertension and CAVD, infers that hypertension will be one of the predominant factors that increase the impact of CAVD on human health in the coming decades

p38 MAP kinase mediated proteoglycan synthesis as a target for the prevention of atherosclerosis

The major underlying pathology of most cardiovascular disease is the chronic inflammatory disease of atherosclerosis. Type 2 diabetes, also recognised as an inflammatory condition, accelerates the development of atherosclerosis. Current therapies for atherosclerosis target risk factors such as elevated blood lipids and hypertension and are of strong but limited efficacy. The "response to retention" hypothesis states that atherosclerosis is initiated by the accumulation of lipids through binding to extracellular matrix, and this is specifically the glycosaminoglycan (GAG) chains on proteoglycans. Many vasoactive agonists stimulate changes in the structure of the GAGs which increase lipid binding and the relevant signalling pathways are a potential therapeutic target. It has recently been demonstrated that the actions of transforming growth factor b; on vascular smooth muscle proteoglycan synthesis involves signalling through p38 MAP kinase and inhibition of this pathway reduces binding of lipids. Inhibition of p38 MAP kinase will elicit a wide spread antiinflammatory response which may alleviate some of the deleterious processes in cardiovascular tissues. This article explores the potential for the actions of p38 MAP kinase inhibitors directed at proteoglycan synthesis in vascular smooth muscle to contribute to the beneficial outcomes from targeting p38 MAP kinase for the prevention of cardiovascular disease

Comparative Evaluation of Azadirachta indica (Neem) Chip and Soft Tissue Diode Lasers as a Supplement to Phase i Periodontal Therapy in Localized Chronic Moderate Periodontitis: A Randomized Controlled Clinical Trial

Introduction. The current trial aimed to assess and compare the efficacy of neem chip and diode laser as a local drug delivery (LDD) agent as a supplement to phase I periodontal therapy in treatment of localized chronic moderate periodontitis. Materials and Methodology. Fourteen systemically healthy participants with 4-6 mm deep periodontal pockets at least in three quadrants (with no alveolar bony defect amenable to respective or regenerative osseous surgery, as seen in orthopantomograph) were selected for the trial. One week after phase I therapy, 10% absorbable chip of neem (commercially prepared by staff of a pharmacy college, Sheriguda, India) was placed in the periodontal pocket on one site, and soft tissue diode laser pocket sterilization was performed on the other site of the arch. Remaining one site was considered as a control. Parameters recorded clinically were plaque index (PI), papillary bleeding index (PBI), probing pocket depth (PPD), and relative attachment level (RAL) measured at baseline, 21st day, and one month postoperatively. Results. Statistically significant improvements were observed in all clinical parameters at one month as compared to baseline for both treatment groups. Conclusion. Neem chip supplemented with phase I therapy showed best improvement in clinical parameters followed by laser supplemented with phase I therapy in comparison to phase I therapy alone at one month follow-up. Clinical Significance. Neem chips are nature's products, affordable without side effects, with a potential to be used as a local drug delivery agent in treating moderate chronic periodontitis