Brown fat is better ?

Warfarin use is increasing - does that mean there is going to an increase in the intracranial bleeds in clinical practice?
In a recent study from Finland, it was shown there was increased use of warfarin to prevent thrombotic episodes ( atrial fibrillation) there was no corresponding increase in the intracranial bleeds.
Effect of Increased Warfarin Use on Warfarin-Related Cerebral Hemorrhage
Juha Huhtakangas, MD , A Longitudinal Population-Based Study
Results—The proportion of warfarin users among the population increased 3.6-fold from 0.68% in 1993 to 2.28% in 2008. Of a total of 982 patients with ICH, 182 (18.5%) had warfarin-related ICH. One-year survival rate after onset of stroke was 35.2% among warfarin users and 67.9% among nonusers. The annual incidence (P=0.062) and 28-day case fatality of warfarin-related ICHs (P=0.002) decreased during the observation period. Warfarin users were older (mean difference 6.6; 95% CI, 5.0 to 8.1; P<0.001) than nonusers. Admission international normalized ratio values above the therapeutic range (2.0 to 3.0) decreased through the observation period, suggesting improved control of anticoagulant therapy over time. Conclusions—The annual incidence and case fatality of warfarin-related ICHs decreased, although the proportion of warfarin users almost quadrupled in our population.

Heparin neutralization

Is there a better way to neutralize or remove the excess heparin from the patients?

In the new study, Krzysztof Szczubialka and colleagues point out doctors often want to remove heparin from the blood of patients undergoing surgery or other procedures immediately after completing the procedure. Leaving the heparin alone could lead to unwanted bleeding.

Doctors now eliminate heparin by giving patients protamine, a drug that stops heparin's anticoagulant effects. However, they are seeking a better drug because protamine carries a risk of serious side effects.The scientists describe development of a potential new approach that involves use of microscopic beads of a polymer made from modified chitosan, a material obtained from shellfish. In laboratory tests, the beads reduced concentrations of heparin to nearly zero within 10 minutes.

Coffee - is it safe in hypertensive patients who drink coffee?

In many Indian families early morning Coffee drinking is common and that happens even before taking the blood pressure medications.  There is a concern about the effect of coffee on blood pressure and cardiovascular risks. Coffee can increase the blood pressure which may be for transient period.

In the recent issue of American journal of clinical nutrition AE Mesas et al discussed about the implications of coffee intake in hypertensive patients. (The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis – Oct 2011 AJCN).

Non communicable diseases

Non-communicable diseases (NCDs)
Infectious diseases were given maximum attention in the past. All the Governments (health departments) in different countries focused on the prevention and treatment of infectious diseases and controlled their spread. Now they are realizing that the non-communicable disease related morbidity and mortality is increasing across the world. It was initially thought that this is a phenomenon only in the developed nations and urban societies. Some studies have shown that it is the poor nations who are going to see this change and its effects. Even the rural people are also going to be affected like the urban populations. This will be affecting the economic status of the people and countries.

Early intervention with rosuvastatin decreases the lipid components of the plaque in acute coronary syndrome: analysis using integrated backscatter IVUS (ELAN study). Blue becomes green after using the Rosuvastatin suggesting the reduction of lipid. (in IB -IVUS)

New Light On Detection of Bacterial Infection: Polymers Fluoresce in the Presence of Bacteria


Professor Sheila MacNeil, an expert in tissue engineering and wound healing, explained: "The polymers incorporate a fluorescent dye and are engineered to recognise and attach to bacteria, collapsing around them as they do so. This change in polymer shape generates a fluorescent signal that we´ve been able to detect using a hand-held UV lamp."

Imaging inflammatory Large Vessel Vasculitides (LVV)

Young lady (22 years) came to the vascular surgery clinic with low-grade fever, loss of weight, body pains, tenderness in the carotid triangle and weak radial pulsations in both the hands. There were no vascular risk factors or joint pains. Giant-cell arteritis (GCA) and Takayasu’s arteritis (TA) are the commonest large-vessel vasculitides (LVV) in such patients. Imaging studies are increasingly being used to diagnose and to monitor LVV. The aim of this presentation is to discuss a case and review the literature on imaging studies.

Imaging studies play a central role in diagnosing and monitoring the large vessel vasculitides (giant-cell and Takayasu’s arteritis). CT or MRI, TEE can examine the deep and central large vessels, while color Doppler ultrasound and MRI have been used with promising results to investigate the temporal arteries. Positron emission tomography is very sensitive in detecting large-vessel inflammation, although it does not delineate the vessel wall. Imaging procedures can also be used to monitor the disease course. However, imaging signs of inflammation may sometimes persist despite clinical remission and, conversely, seemingly unaffected vessels may develop alterations later on. The commonest angiographic findings in Takayasu’s disease are long, smooth vascular stenoses and sometimes occlusions and aneurysms. However, angiography cannot demonstrate early vasculitic lesions such as vessel wall alterations and is thus not useful for early diagnosis. 

Takayasu's disease

Multiple dilatations of aortic arch vessels and aortic dilatation. - Aortitis - Takayasu's disease

Is Obesity getting the proper attention? A noncommunicable disorder! 

Stroke and intracranial interventions

Can interventions for Intracranial vascular disease prevent stroke better than medical therapies?

Carotid artery disease is recognized as a predisposing factor for the stroke in the diabetic or elderly hypertensive patients. The stroke in such patients is prevented by medical therapies and interventions. Segmental extra cranial carotid artery disease is amenable for endarterectomy or angioplasty stenting. But the intracranial vascular disease is not easily amenable for the operations or interventions. After succeeding with angioplasty and stenting of the extra cranial vessels the attention is now focused on the intracranial vascular repairs with angioplasty and stenting. The intracranial vessels are small and delicate. They can need much more careful handling and softer devices to pass through them and at the same time hard enough to dilate stenotic lesions.The 30-day rate of stroke or death associated with stenting in the SAMMPRIS trial (14.7%) is nearly 2.5 times as high as the 6% rate associated with stenting of symptomatic extracranial carotid-artery stenoses in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST, NCT00004732).