Introduction: Cardiovascular disease (CVD) is the leading cause of death worldwide. Squalene (SQ), an intermediate for the cholesterol biosynthesis, has been proposed to act similarly to statins via inhibition of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase in the liver. Purpose: This paper explores the effects of SQ in CVD. Methods: A systematic review of the literature was performed to identify relevant studies about SQ and CVD. A comprehensive search in Medline and Scopus for relevant studies published between the years 1946 and 2019 was performed. The main inclusion criteria were that the study was published in English; that the study reported association or effect of SQ and CVD; and that CVD should be related to lifestyle variables, aging, or experimentally induced conditions. Results: The literature searches identified 5562 potentially relevant articles, whereby 21 studies met the inclusion criteria. There were three human studies and 18 animal experimental studies included in this paper. Only one human study reported positive outcome of SQ in CVD. The remaining two studies reported inconsistent and/or no effect. For animal studies, 15 studies reported positive effect while the remaining reported negative and/or no effect of SQ on various related parameters. Conclusions: This evidence-based review emphasizes the potential of SQ being used for cardiovascular-related diseases. The effect of SQ, especially of plant-based warrants further exploration. Controlled human observational studies should be performed to provide comprehensive evidence.

The Efficacy of Squalene in Cardiovascular Disease Risk-A Systematic Review.

In the present study, we assessed whether nootkatone (NKT), a sesquiterpene in edible plants, can provide protection against dyslipidemia, intramyocardial lipid accumulation, and altered lipid metabolism in a rat model of myocardial infarction (MI) induced by subcutaneous injections of isoproterenol (ISO, 85 mg/kg) on days 9 and 10. The rats were pre- and co-treated with NKT (10 mg/kg, p.o.) administered daily for 11 days. A significant reduction in the activities of myocardial creatine kinase and lactate dehydrogenase, as well as non-enzymatic antioxidants, and alterations in lipids and lipoproteins, along with a rise in plasma lipid peroxidation and intramyocardial lipid accumulation, were observed in ISO-treated rats. ISO administration induced alterations in the activities of enzymes/expressions that played a significant role in altering lipid metabolism. However, NKT treatment favorably modulated all biochemical and molecular parameters altered by ISO and showed protective effects against oxidative stress, dyslipidemia, and altered lipid metabolism, attributed to its free-radical-scavenging and antihyperlipidemic activities in rats with ISO-induced MI. Additionally, NKT decreased the accumulation of lipids in the myocardium as evidenced from Oil red O staining. Furthermore, the in vitro observations demonstrate the potent antioxidant property of NKT. The present study findings are suggestive of the protective effects of NKT on dyslipidemia and the underlying mechanisms. Based on our findings, it can be suggested that NKT or plants rich in NKT can be promising for use as a phytopharmaceutical or nutraceutical in protecting the heart and correcting lipid abnormalities and dyslipidemia, which are risk factors for ischemic heart diseases.

https://www.mdpi.com/1420-3049/25/23/5656/pdf

Nootkatone, a Dietary Fragrant Bioactive Compound, Attenuates Dyslipidemia and Intramyocardial Lipid Accumulation and Favorably Alters Lipid Metabolism in a Rat Model of Myocardial Injury: An In Vivo and In Vitro Study.

Acute myocardial infarction (AMI) is one of the leading causes of death among adults in older age. Understanding mechanisms how organism responds to ischemia is essential for the ischemic patient's prevention and treatment. Despite the great prevalence and incidence only a small number of studies utilize a metabolomic approach to describe AMI condition. Recent studies have shown the impact of metabolites on epigenetic changes, in these studies plasma metabolites were related to neurological outcome of the patients making metabolomic studies increasingly interesting. The aim of this study was to describe metabolomic response of an organism to ischemic stress through the changes in energetic metabolites and aminoacids in blood plasma in patients overcoming acute myocardial infarction. Blood plasma from patients in the first 12 h after onset of chest pain was collected and compared with volunteers without any history of ischemic diseases via NMR spectroscopy. Lowered plasma levels of pyruvate, alanine, glutamine and neurotransmitter precursors tyrosine and tryptophan were found. Further, we observed increased plasma levels of 3-hydroxybutyrate and acetoacetate in balance with decreased level of lipoproteins fraction, suggesting the ongoing ketonic state of an organism. Discriminatory analysis showed very promising performance where compounds: lipoproteins, alanine, pyruvate, glutamine, tryptophan and 3-hydroxybutyrate were of the highest discriminatory power with feasibility of successful statistical discrimination.

/pdf/nmr-plasma-metabolomics-study-of-patients-overcoming-acute-3gpf43e65g.pdf

NMR plasma metabolomics study of patients overcoming acute myocardial infarction: in the first 12 h after onset of chest pain with statistical discrimination towards metabolomic biomarkers.

Altered expression of a disintegrin and metalloproteinase 10 in peripheral blood mononuclear cells in type 2 diabetes mellitus patients with the acute coronary syndrome: a pilot study

BACKGROUND
Acute chest pain (aCP) can be a symptom of life-threatening diseases such as acute coronary or aortic syndrome; however, aCP often is not of cardiac origin. The current recommendations for pre-hospital drug treatment in patients with aCP are unclear.


METHODS
We conducted a retrospective cohort study of 822 patients with aCP who were treated by emergency physicians (EP). The causes of aCP were classified as follows: non-ST-segment elevation acute coronary syndrome (NSTE-ACS), acute aortic syndrome, hypertensive crisis, cardiac arrhythmia, musculoskeletal causes, and other causes. The suspected diagnoses on admission were compared with the discharge diagnoses, and the pre-hospital administration of acetylsalicylic acid (ASA) and unfractionated heparin (UFH) was analyzed. It was also investigated which parameters improved diagnostic accuracy.


RESULTS
The positive predictive value of diagnosis by an EP was 39.7%. NSTE-ACS was the most common suspected diagnosis (74.7%), but was confirmed in the hospital in only 26.3% of cases. ASA was administered in 51%, UFH in 55%, and both drugs in 46.4% of cases. Many patients whose in-hospital diagnosis was not NSTE-ACS had been treated with anticoagulants before their arrival in the hospital: ASA in 62.9% of cases, UFH in 66.0%, and both in 56.5%.


CONCLUSION
Despite low pre-hospital diagnostic accuracy, ASA and UFH are often given to patients with acute chest pain who are treated by EPs before their arrival in the hospital. The pre-hospital measurement of hsTrop-T might help differentiate NSTE-ACS from other causes of acute chest pain. This is important, because current guidelines do not provide clear recommendations for the pre-hospital pharmacotherapy of NSTE-ACS.

Acute Chest Pain-Diagnostic Accuracy and Pre-hospital Use of Anticoagulants and Platelet Aggregation Inhibitors.

Introduction 

Irrespective of underlying hyperlipidemia, the serum lipid profile witnesses a phasic fluctuation immediately after a major cardiovascular event. This study aims to evaluate the change in serum lipid profile in patients with acute myocardial infarction (AMI).

Methods

It was a prospective, cross-sectional study conducted in the department of cardiology, Shalamar Hospital, and Punjab Institute of Cardiology, from October until December 2018, focusing on patients admitted with ST-elevation myocardial infarction (STEMI). The patient's demographics and lipid profile (in mg/dl) within the first 24 hours and after 48 hours of the event were recorded.

Results

The mean serum total cholesterol (TC) levels decreased from 207.5 ± 30.5 to 192.4 ± 49.3 after 48 hours (p-value <0.0001). Mean serum triglyceride (TGs) levels increased from 153.8 ± 10.2 to 183.8 ± 14.8 (p-value <0.0001). Mean serum low density lipid-cholesterol (LDL-C) decreased from 149.0 ± 41.2 to 133.4 ± 54.0 (p-value = 0.0003). Mean serum high density lipid-cholesterol (HDL-C) decreased from 46.6 ± 9.9 to 40.7 ± 11.8 (p-value <0.0001).

Conclusion

Phasic fluctuations in serum lipid profile are observed after acute myocardial infarction (AMI). The trend that follows include reduced TC, LDL-C, and HDL-C, and increased TGs. Periodic lipid profile must be evaluated in all patients admitted for AMI to understand the changing trend, initiate lifestyle measures to reach target lipid levels, and predict the choice of lipid-lowering therapy.

/pdf/lipid-profile-of-patients-with-acute-myocardial-infarction-4e0fsorukf.pdf

Lipid Profile of Patients with Acute Myocardial Infarction (AMI)

Background: Child sex ratio has been declining over a period of time. Preference for a male child by the family leading to sex selective abortion is found to be a major factor which may have adverse impact on the social structure. This study was undertaken to find out the gender preference and awareness on PCPNDT act among antenatal women. Methodology: A cross-sectional study was conducted among 100antenatal women attending to Outpatient department of two tertiary care hospitals and willing to participate.Information was obtained using a pre- tested questionnaire on order of pregnancy, gender preference by the mother, by the family, awareness on PCPNDT etc. Results: Majority of the mothers were in the age group of 21 to 30 years (83%) with mean age 23.03 yrs + 3.6. Of them 42% were primigravida and 58% were of 2 nd order and above. Onethird (27%) preferred male child in the present pregnancy. Preference for male child was more among the family members ( 43%). It was more among those with at least one living girl child. About 58 % of the mothers were aware of PCPNDT Act. Of these, 89% were aware that sex selection is punishable. Awareness about PCPNDT was significantly high among literates as compared to illiterates. About 18 % of the mothers tried to know the sex of the present fetus by USG. Conclusion: Having male child is more commonly a family’s preference and seen in families with at least one girl child. While following the present trend of small family with couples having two or only one child, a family is considered complete only when couples have both male and female children. This concept is found to be the underlying reason for preference of male child in majority of the cases.

A Study on Gender Preference and Awareness on Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act Among Antenatal Women in Visakhapatnam City

Introduction

Heparin-induced thrombocytopenia (HIT) is by far the most relevant pathological association of it encountered by clinicians. It is an immune-mediated phenomenon caused by antibodies directed against complexes of heparin molecules and platelet factor 4 (PF4). HIT is a considerable side effect in patients of acute coronary syndromes (ACS). Its prevalence and associated outcomes in ACS patients have not been studied sufficiently except for clinical trials. The objective of this study was to assess the frequency of HIT in patients presenting with ACS.

Methods

This was an observational study with 272 patients between 40 and 70 years of either gender presenting with ACS within 24 hours of the first appearance of symptoms. Blood samples for baseline platelet count were taken before heparin therapy. Then, patients were subsequently administered low molecular weight heparin 5000 units stat, followed by 12 units/kg/hr for 72 hours of intravenous infusion. Blood samples were repeated for platelet count on Day 5. Thrombocytopenia was defined as per the recommendation of American College of Cardiology as " ≥50% decline in platelets (below 150 x 109/L in most patients), which may occur immediately following heparin exposure (rapid presentation) or up to three weeks following exposure (delayed presentation)." Reports were assessed for the level of platelets. Data were entered and analyzed using SPSS version 22 (IBMCorp, Armonk, NY, US).

Results

The incidence of HIT was observed in 9.56% (n=26). In the HIT group, the mean platelet count on Day 5 was 109.81 ± 78.06 x 109/L. The incidence of HIT in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) were equal but higher than that in unstable angina (UA) (p-value=0.01). The incidence of HIT was also significantly higher in the group that presented late to the hospital (after 12 hours of symptom onset) (p-value=0.001).

Conclusion

The risk of HIT is more prominent in patients with myocardial infarction and in those who have a duration of symptoms more than 12 hours at the time of hospital presentation. Cardiologists and specialists of internal medicine have to take precautions while administrating heparin therapy in these high-risk patients, to avoid any complications.

Heparin-induced Thrombocytopenia in Acute Coronary Syndrome.

Introduction Hypertension is a very common risk factor for erectile dysfunction (ED). In recent time, changes in lifestyle has led to an increase in the prevalence of hypertension, which has increased the risk of ED. The purpose of this study is to assess the prevalence of ED in hypertensive patients and compare various domains of sexual activity between hypertensive and normotensive participants. Methods This case-control study was conducted in an outpatient department of a tertiary health care hospital in Pakistan from March 2019 to September 2019. Two hundred and twelve clinically diagnosed hypertensive patients were enrolled and were identified as case group. Control group consisted of 212 people, without any history of hypertension. Sexual function was assessed with the International Index of Erectile Function (IIEF). Results The prevalence of erectile dysfunction in hypertensive group was 61.79%, compared to 20.28% in normotensive group. Erectile weakness (OR = 4.32, CI 2.64-7.05), impaired morning erection (OR = 5.02, CI 2.98-8.47), complete erectile failure (OR = 2.32, CI 1.14-4.75), impaired spontaneous erection (OR = 5.45, CI 3.28-9.03), ejaculatory disturbances (OR = 5.20, CI 2.96-9.12) and reduced sexual interest (OR = 5.12, CI 3.04-8.64) were found to be significantly higher in patients with hypertension compared to normotensive participants. Conclusion This study has found ED to be prevalent in hypertensive patients. Identifying and acknowledging hypertension as a risk factor may help identify patients with ED and reinforce the clinician's importance of asking sexual history of hypertensive patients.

Comparison of the Prevalence of Erectile Dysfunction Between Hypertensive and Normotensive Participants: A Case-Control Study.

Introduction: The causes of Male infertility are multifactorial and varicocele occupies a significant position with a prevalence of 19-41% in cases of primary infertility and 45-81% among cases of secondary infertility. Several studies have shown a significant correlation on varicocele and altered semen parameters. The aim of present study was to evaluate the effects of surgical varicocelectomy in cases of clinical and subclinical varicocele on the seminal parameters with a special focus on the sperm morphology, concentration and motility of the sperms. Material and methods: A prospective cross sectional study for a period of two years was conducted and all patients with clinical and subclinical varicoceles (diagnosed radiologically) were included and varicocelectomy was done. Pre and postoperative semen samples were collected and evaluated for alterations in semen concentration, motility and morphology of sperm. The data was analyzed with SPSS software version 20 for windows 10 and level of significance was assessed by paired t test, by considering p value less than 0.05. Results: 125 cases were included and 18-25 years was the major age group and left sided varicocele was commonest. 99 clinical and 26 subclinical varicoceles were identified and corrected by microsurgical approach in all cases. In our study a highly significant increase in sperm count was noticed in clinical and subclinical varicocele after varicocelectomy, but there was no significant difference in sperm morphology in both the groups. Discussion: To conclude our study demonstrated a clear increase in the semen parameters, i.e., sperm morphology, concentration and motility in clinical and subclinical cases of varicocele after surgical repair.

/pdf/evaluation-of-effects-of-varicocele-repair-on-seminal-4bskoonu5j.pdf

Suresh Kumar

Papers

Lipid Profile of Patients with Acute Myocardial Infarction (AMI)

A Study on Gender Preference and Awareness on Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act Among Antenatal Women in Visakhapatnam City

Heparin-induced Thrombocytopenia in Acute Coronary Syndrome.

Comparison of the Prevalence of Erectile Dysfunction Between Hypertensive and Normotensive Participants: A Case-Control Study.

Evaluation of Effects of Varicocele Repair on Seminal Parameters in Cases of Clinical and Subclinical Varicocele – A Two Year Study