| EDITOR'S PAGE | ||
Editor's page january 2019  | p. 1 | |
| Ravi R Kasliwal DOI:10.4103/2250-3528.252009 | ||
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| ORIGINAL ARTICLES |  | |
  | Clinical characteristics of peripartum cardiomyopathy patients admitted in tertiary hospital | p. 2 |
| Jishu Deb Nath, Anannya Das, Rajat Sanker Roy Biswas DOI:10.4103/JCPC.JCPC_21_18 Background: Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition marked by left ventricular (LV) dysfunction and heart failure. The disease incidence is rising and most of the cases are identified now due to availability of widespread echocardiography and possible suspicion by cardiologist. Materials and Methods: This was hospital-based study conducted in the department of medicine of a tertiary hospital, Bangladesh. The study population consisted of postpartum patients admitted to medicine ward for evaluating dyspnea from January 2012 to January 2017. Totally 31 patients were diagnosed as PPCM and taken as a sample after exclusion of all criteria. Results: Most of the patients belonged to 20–24 years of age group (51.6%, n = 16) and most patients developed PPCM in primigravida (51.6%). About 67.7% admitted from rural area and 32.3% from urban area. Exertional breathlessness (45.1%, n = 14) and orthopnea (32.2%, n = 10) are the predominant symptoms in all age groups, while exertional breathlessness was 50% presentations from early age group and 14.3% from elder group, while orthopnea was Observed 70% from early age group. Nearly 9.3% of participants in the study had twin pregnancy. Association of gestational hypertension and diabetes mellitus was found in this study group as 12.9%, n = 4, and 16.1%, n = 5. Majority of the patients (35.5%, n = 11) had no specific electrocardiography changes; sinus tachycardia and ST-T changes were found equally (22.5%, n = 7). About one-third of the patients (29%, n = 9) were found to have severe LV systolic dysfunction (ejection fraction [EF] <30%) and more than half of the patients had moderate LV systolic dysfunction (EF: 31%–40%). Conclusion: As PPCM is rising worldwide, so proper suspicion, early referral, early intervention, and prevention can overcome the misdiagnosis of PPCM which often leads to clinical deterioration and in some instances death. | ||
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 | Clinical and angiographic profile of young patients with ischemic heart disease: A central India study | p. 6 |
| Sunita Dinkar Kumbhalkar, Vikas V Bisne DOI:10.4103/JCPC.JCPC_22_18 Objective: The present study was undertaken in young patients of ischemic heart disease (IHD) to assess clinical, biochemical and angiographic profile, conventional and newer risk factors, and correlation of risk factors with significant and nonsignificant coronary artery disease (CAD). Materials and Methods: This was a hospital-based cross-sectional study conducted in 70 cases of young IHD (male ≤35 years and females ≤40 years). Patients were evaluated for clinical, biochemical and angiographic profiles, and conventional risk factors such as dyslipidemia, hypertension (HT), diabetes mellitus (DM), and family history of premature CAD (PCAD). Newer risk factors such as lipoprotein (a) (Lp [a]), homocysteine, and plasma fibrinogen were also assessed in some (n = 44) cases. Results: Mean age of patients was 32.97 ± 3.93 years; 11 (15.7%) were women. Various risk factors such as tobacco/gutka chewing, HT, smoking, DM, and family history of PCAD were observed in 35.7%, 22.8%, 17.1%, 11.5%, and 8.6% of patients, respectively. Nearly 77.6% of patients presented with anterior wall myocardial infarction and 61.4% were having moderate left ventricular dysfunction on echocardiography. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and TC/high-density lipoprotein cholesterol (TC/HDL-C) were increased in 38.6%, 41.4%, 32.9%, and 25.7% patients, respectively. Newer risk factors such as Lp (a), homocysteine, and plasma fibrinogen were elevated in 61.4%, 77.3%, and 18.2% of patients, respectively. On coronary angiography, single-vessel disease was found in more than half of the patients (57.1%) followed by double-vessel disease (11.5%) and triple-vessel disease (7.1%). Coronary angiogram was normal in 24.3% of patients. Positive family history of PCAD, serum TGs, TC/HDL-C, and LDL-C/HDL-C were significantly (P < 0.05) associated with significant CAD as compared to nonsignificant CAD, whereas no such correlation was found in relation to newer risk factors. Conclusion: Indian males in South Asian population appear more prone to develop CAD; therefore, screening for risk factors should start at an earlier age. Smoking and tobacco chewing cessation, promotion of physical activities, and healthy dietary pattern have to be strongly encouraged in this vulnerable group. | ||
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 | Levels of physical inactivity in rural and urban Tamil Nadu, India: A cross-sectional study | p. 13 |
| Carol Susan Devamani, Anu Mary Oommen, GK Mini, Vinod Joseph Abraham, Kuryan George DOI:10.4103/JCPC.JCPC_32_18 Background and Objectives: Physical inactivity is an important cardiovascular risk factor. This study assessed the prevalence and factors associated with insufficient physical activity (PA) in urban and rural Vellore, Tamil Nadu, India, among adults aged 30–64 years. Methodology: A cross-sectional World Health Organization STEPS survey was carried out in 48 wards of Vellore Municipality and nine rural villages of Tamil Nadu in 2010–2012. Adults (n = 6164, men 43.9%) aged 30–64 years were interviewed using the Global PA Questionnaire (2390 urban and 3774 rural). Insufficient PA was defined as not meeting the recommendation of 150 min of moderate aerobic PA, or 75 min of vigorous aerobic PA, or an equivalent combination, achieving at least 600 metabolic equivalent-minutes per day. Results: The prevalence of insufficient PA was 63.3% (95% confidence interval [CI]: 61.3%–65.3%) in the urban area and 40.6% (95% CI: 39.0%–42.2%) in the rural area. Women had a higher prevalence of insufficient PA compared to men, in both urban (70.8% vs. 53.8%) and rural (44.5% vs. 35.6%) areas. Those with higher education (odds ratio [OR]: 1.36, 95% CI: 1.20–1.53) and who were unemployed (OR: 2.97, 95% CI: 2.59–3.39) reported insufficient PA which was significantly higher than their counterparts. While urban participants had higher leisure time PA, rural participants had higher work- and travel-related PA. Conclusions: The high prevalence of insufficient PA found in this study shows that targeted interventions are needed to reduce insufficient PA, especially for women and urban populations. | ||
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 | Distribution of conventional lipids in Indians with premature coronary artery disease: A substudy of the premature coronary artery disease registry | p. 18 |
| Rahul S Patil, TR Raghu, CN Manjunath, Santu Ghosh, Laxmi H Shetty DOI:10.4103/JCPC.JCPC_33_18 Context: Conventional lipids in young Indians with Coronary Artery Disease. Aims: To study distribution of conventional lipids and their quantification in demographic subgroups of Indians with Premature Coronary Artery Disease (PCAD). Settings and Design: PCAD Registry is a Prospective Multisite Descriptive Observational study of Indians aged below 40 years with Coronary Artery Disease. This Lipid sub study is based on preliminary data of first year of the PCAD registry. Methods and Material: Of 1380 patients registered in PCAD registry, 1061 satisfied entry criteria. Conventional lipids were estimated using commercially available kits. Each of risk factor subgroups were compared by statistical analysis of lipid values. Statistical significance was derived by independent t-test or one-way ANOVA wherever appropriate. The distribution of different lipid profile parameters was visualised by nonparametric density plot. The data was analysed by statistical software R version 3.5.0. Results: A total of 1380 patients were registered. of which 1061 patients satisfied the entry criteria and were enrolled for the lipid analysis study. The mean age of all patients registered was 34.27 (±4.30) years. Mean total cholesterol of entire study population was 171.95 ± 47.11, LDL was 116.39 ± 84.81 mg/dl, HDL was 34.50 ± 9.64, TG was 165.18 ± 87.11, non-HDL was 138.09 ± 46.18. Conclusions: Among all the conventional lipid parameters, low HDL-C along with high TGs seems to be more relevant for premature coronary artery in Indians. Primary cardiovascular disease prevention for Young Indians cannot be solely on the basis of LDL-C. All risk factors should be considered together. Larger sample population studies are needed to draw population specific cutoff values for risk factors and to discover novel risk factors (CTRI/2018/03/012544). | ||
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| VIEW POINT | | |
 | Cardiometabolic risks in India | p. 25 |
| Gundu H R Rao DOI:10.4103/JCPC.JCPC_39_18 In a recent article in this journal, we discussed diabetes and Cardiovascular disease (CVD) risks in Indians living abroad. The article was written to complement the information that was published by an elite group of the American Heart Association (AHA);-"the council members of the various subcommittees." In the journal Circulation, AHA published a scientific statement about the CVD risk of Indians living in the USA. In the June issue of the journal PLoS Medicine, The George Institute for Global Health (GIGH), Sydney, Australia, with collaborators from; Harvard T. H. Chan School of Public Health, USA; Department of Economics, University of Gottingen, Heidelberg University, Germany; School of Public Health Johannesburg, South Africa; King's College London, UK, Indian Institute of Public Health, and Public Health Foundation of India, have published a one of a kind article on, "Geographic and sociodemographic variation of CVD disease risk in India: A cross-sectional study of 797,540 adults." I am writing this article, as a complement to the topic reviewed by the George Institutes of Global Health and associates and other expert groups. The specific objectives of this academic exercise by the GIGH were, to determine how the CVD risk- and the factors that determine risk varies among states in India, by rural-urban location, and by individual-level sociodemographic characteristics. Rajeev Gupta and associates from Jaipur, under the aegis of South Asian Society on Atherosclerosis and Thrombosis, did a study in 2012, on "Regional variations in CVD risk in India: India heart watch." The researchers found a wide regional variation in CVD mortality. They concluded, "that although no nationwide study of risk factors exists, there were significant state-level and rural-urban level differences in major CVD risk factors such as smoking, obesity, central adiposity, hypertension, hypercholesterolemia, and diabetes. They also stressed the need for uniform protocols, to assess the regional differences. Whereas, the report by the GIGH Collaborators group, did pooled analysis of CVD risk for 797,540 adults across India, and identified important variation in risk among individuals living in different States. According to them, CVD risk was the highest in the northern (Himachal Pradesh, Uttarakhand), northeastern (West Bengal, Nagaland, Manipur, and Mizoram), and Southern States (Kerala, Andhra Pradesh) of India. CVD risk was found to be higher in urban areas, that too among males, while mean body mass index was higher among wealthy, blood glucose, high systolic blood pressure was common in poor people of middle and older age. We have access to data from three important studies, related to the variation of CVD risk in Indians living in India, as well as abroad. It is high time, that we use these data to develop guidelines, guidance statements, novel clinical studies for validating safety and efficacy of complementary therapies for early risk factors such as oxidative stress, inflammation, and endothelial dysfunction, put together integrated noninvasive diagnostic platforms for risk assessment, risk prediction, and reduction or reversal of metabolic diseases. Having said that, I would like to emphasize the need for a national platform, to address the issues related to this very important public health problem, and to coordinate the prevention strategies. | ||
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| CASE REPORT | | |
 | Homozygous familial hypercholesterolemia with valvulopathy | p. 34 |
| Ashokan Nambiar, Robin George Manappallil, VG Pradeep Kumar, Avinash Sarpamale DOI:10.4103/JCPC.JCPC_26_18 Familial hypercholesterolemia (FH) is an autosomal codominant genetic disorder of lipid metabolism. The occurrence of its homozygous form is rare. This is a case of a young girl who presented with syncope and was found to have multiple tuberous xanthomas and valvulopathy, along with deranged lipid profile, suggestive of homozygous FH. | ||
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| RECENT LANDMARK TRIALS | | |
 | Should aspirin be used for primary prevention? | p. 38 |
| Mohit Bhagwati, Rahul Mehrotra DOI:10.4103/JCPC.JCPC_54_18 | ||
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Monday, February 11, 2019
Clinical and Preventive Cardiology
Clinical and Preventive Cardiology
| Editor's page january 2019 Ravi R Kasliwal Journal of Clinical and Preventive Cardiology 2019 8(1):1-1 |
| Clinical characteristics of peripartum cardiomyopathy patients admitted in tertiary hospital Jishu Deb Nath, Anannya Das, Rajat Sanker Roy Biswas Journal of Clinical and Preventive Cardiology 2019 8(1):2-5 Background: Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition marked by left ventricular (LV) dysfunction and heart failure. The disease incidence is rising and most of the cases are identified now due to availability of widespread echocardiography and possible suspicion by cardiologist. Materials and Methods: This was hospital-based study conducted in the department of medicine of a tertiary hospital, Bangladesh. The study population consisted of postpartum patients admitted to medicine ward for evaluating dyspnea from January 2012 to January 2017. Totally 31 patients were diagnosed as PPCM and taken as a sample after exclusion of all criteria. Results: Most of the patients belonged to 20–24 years of age group (51.6%, n = 16) and most patients developed PPCM in primigravida (51.6%). About 67.7% admitted from rural area and 32.3% from urban area. Exertional breathlessness (45.1%, n = 14) and orthopnea (32.2%, n = 10) are the predominant symptoms in all age groups, while exertional breathlessness was 50% presentations from early age group and 14.3% from elder group, while orthopnea was Observed 70% from early age group. Nearly 9.3% of participants in the study had twin pregnancy. Association of gestational hypertension and diabetes mellitus was found in this study group as 12.9%, n = 4, and 16.1%, n = 5. Majority of the patients (35.5%, n = 11) had no specific electrocardiography changes; sinus tachycardia and ST-T changes were found equally (22.5%, n = 7). About one-third of the patients (29%, n = 9) were found to have severe LV systolic dysfunction (ejection fraction [EF] <30%) and more than half of the patients had moderate LV systolic dysfunction (EF: 31%–40%). Conclusion: As PPCM is rising worldwide, so proper suspicion, early referral, early intervention, and prevention can overcome the misdiagnosis of PPCM which often leads to clinical deterioration and in some instances death. |
| Clinical and angiographic profile of young patients with ischemic heart disease: A central India study Sunita Dinkar Kumbhalkar, Vikas V Bisne Journal of Clinical and Preventive Cardiology 2019 8(1):6-12 Objective: The present study was undertaken in young patients of ischemic heart disease (IHD) to assess clinical, biochemical and angiographic profile, conventional and newer risk factors, and correlation of risk factors with significant and nonsignificant coronary artery disease (CAD). Materials and Methods: This was a hospital-based cross-sectional study conducted in 70 cases of young IHD (male ≤35 years and females ≤40 years). Patients were evaluated for clinical, biochemical and angiographic profiles, and conventional risk factors such as dyslipidemia, hypertension (HT), diabetes mellitus (DM), and family history of premature CAD (PCAD). Newer risk factors such as lipoprotein (a) (Lp [a]), homocysteine, and plasma fibrinogen were also assessed in some (n = 44) cases. Results: Mean age of patients was 32.97 ± 3.93 years; 11 (15.7%) were women. Various risk factors such as tobacco/gutka chewing, HT, smoking, DM, and family history of PCAD were observed in 35.7%, 22.8%, 17.1%, 11.5%, and 8.6% of patients, respectively. Nearly 77.6% of patients presented with anterior wall myocardial infarction and 61.4% were having moderate left ventricular dysfunction on echocardiography. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and TC/high-density lipoprotein cholesterol (TC/HDL-C) were increased in 38.6%, 41.4%, 32.9%, and 25.7% patients, respectively. Newer risk factors such as Lp (a), homocysteine, and plasma fibrinogen were elevated in 61.4%, 77.3%, and 18.2% of patients, respectively. On coronary angiography, single-vessel disease was found in more than half of the patients (57.1%) followed by double-vessel disease (11.5%) and triple-vessel disease (7.1%). Coronary angiogram was normal in 24.3% of patients. Positive family history of PCAD, serum TGs, TC/HDL-C, and LDL-C/HDL-C were significantly (P < 0.05) associated with significant CAD as compared to nonsignificant CAD, whereas no such correlation was found in relation to newer risk factors. Conclusion: Indian males in South Asian population appear more prone to develop CAD; therefore, screening for risk factors should start at an earlier age. Smoking and tobacco chewing cessation, promotion of physical activities, and healthy dietary pattern have to be strongly encouraged in this vulnerable group. |
| Levels of physical inactivity in rural and urban Tamil Nadu, India: A cross-sectional study Carol Susan Devamani, Anu Mary Oommen, GK Mini, Vinod Joseph Abraham, Kuryan George Journal of Clinical and Preventive Cardiology 2019 8(1):13-17 Background and Objectives: Physical inactivity is an important cardiovascular risk factor. This study assessed the prevalence and factors associated with insufficient physical activity (PA) in urban and rural Vellore, Tamil Nadu, India, among adults aged 30–64 years. Methodology: A cross-sectional World Health Organization STEPS survey was carried out in 48 wards of Vellore Municipality and nine rural villages of Tamil Nadu in 2010–2012. Adults (n = 6164, men 43.9%) aged 30–64 years were interviewed using the Global PA Questionnaire (2390 urban and 3774 rural). Insufficient PA was defined as not meeting the recommendation of 150 min of moderate aerobic PA, or 75 min of vigorous aerobic PA, or an equivalent combination, achieving at least 600 metabolic equivalent-minutes per day. Results: The prevalence of insufficient PA was 63.3% (95% confidence interval [CI]: 61.3%–65.3%) in the urban area and 40.6% (95% CI: 39.0%–42.2%) in the rural area. Women had a higher prevalence of insufficient PA compared to men, in both urban (70.8% vs. 53.8%) and rural (44.5% vs. 35.6%) areas. Those with higher education (odds ratio [OR]: 1.36, 95% CI: 1.20–1.53) and who were unemployed (OR: 2.97, 95% CI: 2.59–3.39) reported insufficient PA which was significantly higher than their counterparts. While urban participants had higher leisure time PA, rural participants had higher work- and travel-related PA. Conclusions: The high prevalence of insufficient PA found in this study shows that targeted interventions are needed to reduce insufficient PA, especially for women and urban populations. |
| Distribution of conventional lipids in Indians with premature coronary artery disease: A substudy of the premature coronary artery disease registry Rahul S Patil, TR Raghu, CN Manjunath, Santu Ghosh, Laxmi H Shetty Journal of Clinical and Preventive Cardiology 2019 8(1):18-24 Context: Conventional lipids in young Indians with Coronary Artery Disease. Aims: To study distribution of conventional lipids and their quantification in demographic subgroups of Indians with Premature Coronary Artery Disease (PCAD). Settings and Design: PCAD Registry is a Prospective Multisite Descriptive Observational study of Indians aged below 40 years with Coronary Artery Disease. This Lipid sub study is based on preliminary data of first year of the PCAD registry. Methods and Material: Of 1380 patients registered in PCAD registry, 1061 satisfied entry criteria. Conventional lipids were estimated using commercially available kits. Each of risk factor subgroups were compared by statistical analysis of lipid values. Statistical significance was derived by independent t-test or one-way ANOVA wherever appropriate. The distribution of different lipid profile parameters was visualised by nonparametric density plot. The data was analysed by statistical software R version 3.5.0. Results: A total of 1380 patients were registered. of which 1061 patients satisfied the entry criteria and were enrolled for the lipid analysis study. The mean age of all patients registered was 34.27 (±4.30) years. Mean total cholesterol of entire study population was 171.95 ± 47.11, LDL was 116.39 ± 84.81 mg/dl, HDL was 34.50 ± 9.64, TG was 165.18 ± 87.11, non-HDL was 138.09 ± 46.18. Conclusions: Among all the conventional lipid parameters, low HDL-C along with high TGs seems to be more relevant for premature coronary artery in Indians. Primary cardiovascular disease prevention for Young Indians cannot be solely on the basis of LDL-C. All risk factors should be considered together. Larger sample population studies are needed to draw population specific cutoff values for risk factors and to discover novel risk factors (CTRI/2018/03/012544). |
| Cardiometabolic risks in India Gundu H R Rao Journal of Clinical and Preventive Cardiology 2019 8(1):25-33 In a recent article in this journal, we discussed diabetes and Cardiovascular disease (CVD) risks in Indians living abroad. The article was written to complement the information that was published by an elite group of the American Heart Association (AHA);-”the council members of the various subcommittees.” In the journal Circulation, AHA published a scientific statement about the CVD risk of Indians living in the USA. In the June issue of the journal PLoS Medicine, The George Institute for Global Health (GIGH), Sydney, Australia, with collaborators from; Harvard T. H. Chan School of Public Health, USA; Department of Economics, University of Gottingen, Heidelberg University, Germany; School of Public Health Johannesburg, South Africa; King's College London, UK, Indian Institute of Public Health, and Public Health Foundation of India, have published a one of a kind article on, “Geographic and sociodemographic variation of CVD disease risk in India: A cross-sectional study of 797,540 adults.” I am writing this article, as a complement to the topic reviewed by the George Institutes of Global Health and associates and other expert groups. The specific objectives of this academic exercise by the GIGH were, to determine how the CVD risk- and the factors that determine risk varies among states in India, by rural-urban location, and by individual-level sociodemographic characteristics. Rajeev Gupta and associates from Jaipur, under the aegis of South Asian Society on Atherosclerosis and Thrombosis, did a study in 2012, on “Regional variations in CVD risk in India: India heart watch.” The researchers found a wide regional variation in CVD mortality. They concluded, “that although no nationwide study of risk factors exists, there were significant state-level and rural-urban level differences in major CVD risk factors such as smoking, obesity, central adiposity, hypertension, hypercholesterolemia, and diabetes. They also stressed the need for uniform protocols, to assess the regional differences. Whereas, the report by the GIGH Collaborators group, did pooled analysis of CVD risk for 797,540 adults across India, and identified important variation in risk among individuals living in different States. According to them, CVD risk was the highest in the northern (Himachal Pradesh, Uttarakhand), northeastern (West Bengal, Nagaland, Manipur, and Mizoram), and Southern States (Kerala, Andhra Pradesh) of India. CVD risk was found to be higher in urban areas, that too among males, while mean body mass index was higher among wealthy, blood glucose, high systolic blood pressure was common in poor people of middle and older age. We have access to data from three important studies, related to the variation of CVD risk in Indians living in India, as well as abroad. It is high time, that we use these data to develop guidelines, guidance statements, novel clinical studies for validating safety and efficacy of complementary therapies for early risk factors such as oxidative stress, inflammation, and endothelial dysfunction, put together integrated noninvasive diagnostic platforms for risk assessment, risk prediction, and reduction or reversal of metabolic diseases. Having said that, I would like to emphasize the need for a national platform, to address the issues related to this very important public health problem, and to coordinate the prevention strategies. |
| Homozygous familial hypercholesterolemia with valvulopathy Ashokan Nambiar, Robin George Manappallil, VG Pradeep Kumar, Avinash Sarpamale Journal of Clinical and Preventive Cardiology 2019 8(1):34-37 Familial hypercholesterolemia (FH) is an autosomal codominant genetic disorder of lipid metabolism. The occurrence of its homozygous form is rare. This is a case of a young girl who presented with syncope and was found to have multiple tuberous xanthomas and valvulopathy, along with deranged lipid profile, suggestive of homozygous FH. |
| Should aspirin be used for primary prevention? Mohit Bhagwati, Rahul Mehrotra Journal of Clinical and Preventive Cardiology 2019 8(1):38-41 |
The Voice Performance After Septoplasty
With Surgical Efficacy Demonstrated Through Acoustic Rhinometry and Rhinomanometry
Emre Apaydın'Correspondence information about the author Emre ApaydınEmail the author Emre Apaydın, Aykut İkincioğulları, Mustafa Çolak, Doğan Atan, Serdar Ensari, Hacı Hüseyin Dere
Abstract
Objective
To demonstrate the surgical efficacy of septoplasty using acoustic rhinometry (AR) and anterior rhinomanometry (ARM) and to evaluate the effect of septoplasty on voice performance through subjective voice analysis methods.
Materials and Methods
This prospective study enrolled a total of 62 patients who underwent septoplasty with the diagnosis of deviated nasal septum. Thirteen patients with no postoperative improvement versus preoperative period as shown by AR and/or ARM tests and three patients with postoperative complications and four patients who were lost to follow-up were excluded. As a result, a total of 42 patients were included in the study. Objective tests including AR, ARM, acoustic voice analysis and spectrographic analysis were performed before the surgery and at 1 month and 3 months after the surgery. Subjective measures included the Nasal Obstruction Symptom Evaluation questionnaire to evaluate surgical success and Voice Handicap Index-30 tool for assessment of voice performance postoperatively, both completed by all study patients.
Results
Among acoustic voice analysis parameters, F0, jitter, Harmonics-to-Noise Ratio values as well as formant frequency (F1-F2-F3-F4) values did not show significant differences postoperatively in comparison to the preoperative period (P > 0.05). Only the shimmer value was statistically significantly reduced at 1 month (P < 0.05) and 3 months postoperatively (P < 0.05) versus baseline. Statistically significant reductions in Voice Handicap Index-30 scores were observed at postoperative 1 month (P < 0.001) and 3 months (P < 0.001) compared to the preoperative period and between postoperative 1 month and 3 months (P < 0.05).
Conclusion
In this study, first operative success of septoplasty was demonstrated through objective tests and then objective voice analyses were performed to better evaluate the overall effect of septoplasty on voice performance. Shimmer value was found to be improved in the early and late postoperative periods.
Key Words:
Septoplasty, Voice, Acoustic Rhinometry, Rhinomanometry
Pitch-Synchronous Analysis of Human Voice
C. Julian Chen'Correspondence information about the author C. Julian ChenEmail the author C. Julian Chen, Donald A. Miller
Objective
Based on simultaneous voice and electroglottograph (EGG) signals, to gain a better understanding of human voice production process, to make pitch-synchronous segmentation of voice signals, and to make visual representations of pitch marks and timbre spectra with high resolution.
Methods/Design
The traditional spectrogram segments the voice signals with a process window of fixed size and fixed shift, then performs fast Fourier transformation after multiplied with a window function, typically a Hamming window. Then display power spectrum in both frequency and time. Pitch information and timbre information are mixed. The new design segments the signals into pitch periods, either using the derivatives of the EGG signals or based on the voice signals, then performs Fourier analysis to the segment of signals in each pitch period without using a window function. The pitch information and the timbre information are cleanly separated. The graphical representations of both pitch marks and timbre spectra exhibit high resolution and high accuracy.
Results
Detailed analysis of simultaneously acquired voice and EGG signals provides a more precise understanding of human-voice production process. The transient theory of voice production, proposed by Leonhard Euler in early 18th century, is substantiated with modern data. Based on the transient theory of voice production, a pitch-synchronous spectrogram software is developed, which makes a visual representation of pitch marks and timbre spectra. In addition, the timbre spectrum and the power evolution pattern in each pitch period can be displayed individually.
Conclusions
Simultaneously acquired voice and EGG signals indicates that each glottal closing triggers a decaying elementary wave in the vocal tract. A superposition of those elementary waves constitutes voice. Based on that concept and using EGG data, a pitch-synchronous voice signal processing method is developed. The voice signal is first segmented into pitch periods, then the two ends are equalized. Fourier analysis is applied to obtain the timbre spectrum of each pitch period. High resolution display of timbre spectrum is generated. The power evolution pattern in each pitch period is also displayed.
Key Words:
Human voice, Production, Analysis, Pitch period, Timbre spectra, Graphical display
Spontaneous bacterial peritonitis in hepatitis C virus cirrhotic patients
Does ascitic fluid lactoferrin has a role in the diagnosis and follow up of spontaneous bacterial peritonitis in hepatitis C virus cirrhotic patients p. 53
Soheir Abuelfadl, Ahmed A Heikl, Mahmoud M El-Nokeety, Laila A Rashed
DOI:10.4103/kamj.kamj_27_17
Background Polymorphonuclear leukocyte (PMNL) count in the ascitic fluid (AF) is the gold standard method for the diagnosis of spontaneous bacterial peritonitis (SBP). Its measurement is routinely performed by traditional manual counting which is operator dependent and false-negative results may occur due to lysis of the leukocyte during transport. Aims The aims of the study were to assess the accuracy of AF lactoferrin and the best cutoff value for the diagnosis of SBP and also to compare its level before and after treatment to be used as a marker for follow up. Patients and methods The present study included 150 Egyptian patients with hepatitis C virus-related liver cirrhosis and ascites. The cases were divided into 100 patients with SBP and 50 patients with no SBP based on an elevated AF PMNL count of greater than or equal to 250 cells/mm3, ascitic samples were examined for PMNL count, culture, chemistry, and lactoferrin concentration in non-SBP patients and in SBP patients before and after systemic antibiotic treatment. Results AF lactoferrin concentration is significantly higher in SBP patients than in non-SBP patients with a cutoff value of 75.55 ng/ml, significantly higher in culture positive than in culture-negative SBP patients and its concentration is decreased significantly in SBP patients after systemic antibiotic therapy. Conclusion Elevated AF lactoferrin levels in cirrhotic patients are reliable for the diagnosis and follow up of SBP after systemic antibiotic therapy. The level of AF lactoferrin level is higher in resistant cases of SBP than the cases that respond to systemic antibiotic treatment.
Mast cell, a new player in type 2 diabetes
Nehal Hamdy, Randa F Salam, Nagwa Abd EL-Ghaffar Mohamed
DOI:10.4103/kamj.kamj_18_18
Background Mast cells plays critical role in inflammatory diseases, including cardiovascular and metabolic diseases and their associated complications. These cells exert their physiological and pathological activities by releasing granules containing histamine, cytokines, chemokines, and proteases, including mast cell-specific chymases and tryptases Aim of our study is to detect the role of mast cell in diabetic obese and its correlation to different diabetic complications Method 70 Type 2 diabetic obese patients attending the Diabetes and Endocrinology clinic in Kasr El Ani hospital compared to 15 healthy controls All patients were subjected to: Full medical history, complete physical examination, Anthropometric measurements (BMI, waist circumference) fasting glucose(assessed after 8 hours fasting) –A1C – serum cholesterol –triglycerides-LDL-HDL(assessed after 12 hours fasting) Tryptase level Results Statistical significant difference between patients and control regarding BMI, glucose,cholesterol, HDL, LDL,tryptase (p<0.001) ,triglycerides(p=0.001) Tryptase statistically correlated with BMI,fastingglucose,A1C,triglycerides(p=0.014,r=0.031)/(p=0.012,r=0.297)/(p<0.001,r=0.862),(p=0.039,r=0.247) Higher mean level of tryptase in patients with diabetic complications mainly in retinopathy (32.32 ng/ml) Conclusion Tryptase participate in the pathogenesis of diabetes mellitus and its complication targeting mast cells as novel therapy for diabetes requires further investigations
Does CBD Oil Lower Blood Pressure?
Does CBD Oil Lower Blood Pressure?
This article was originally published at SundayScaries."
High blood pressure is a serious condition that currently affects thousands of adults in America. Statistics show that 33% of adults who are above the age of 20 struggle with high blood pressure and that figure reaches a whopping 66% for those in their mid-60 and over. It goes without saying that high blood pressure is becoming a nasty rising trend, which is only going to worsen if changes to the system aren't made. While there is already a substantial amount of research into hypertension, a succinct cure is yet to be found. And, thanks to the rise of natural medicines, including medical marijuana, many people now suspect that cannabis-based products could provide the answers we have been looking for with regards to lowering blood pressure in modern society.
Hypertension doesn't immediately strike us as a fatal condition when you compare it to aggressive illnesses like cancer of epilepsy. However, high blood pressure has been coined as a silent killer in the medical industry, based on the reality that hypertension is often not accompanied by any warning symptoms. This dreaded condition will put you at a higher risk of having a heart attack, heart failure, strokes, and even kidney disease. It is a condition that must be taken seriously in order to avoid its fatal repercussions.
What Are the Symptoms of Hypertension?
While there are some medical conditions in existence that can be diagnosed at home, high blood pressure is not one of them. It is virtually impossible to tell if your blood pressure is too high without experiencing other negative symptoms and by that point, it could be too late. You should always schedule regular check-ups with your physician to monitor blood pressure and you should make an appointment at your local medical center as soon as possible if you start noticing any of the following symptoms:
- A more severe headache than normal
- Feeling permanently tired
- Problems with your vision
- An irregular heartbeat
- Difficulty breathing
How Can CBD help?
The big question is: "Does CBD oil lower blood pressure?" CBD is a natural that is relatively new to the mainstream market. It is known to help with chronic pain and cancer-related pain, severe diabetes, multiple sclerosis, and Alzheimer's disease. One of its primary uses, however, is to manage and lower the symptoms of anxiety and stress disorders like post-traumatic stress disorder; therefore, lowering your blood pressure. When you feel calm, you are able to relax, so your blood pressure responds accordingly and decreases in time with your heart rate. Cannabidiol is a natural vasodilator; it will help ensure that your blood is flowing easily and smoothly. A particularly nasty symptom of hypertension is that it can cause irreversible damage to your arteries and heart. You then tend to end up with conditions like coronary heart disease. Fortunately, CBD has proven to be effective to alleviate the negative consequences of affected blood vessels.
The Benefits of Taking CBD for High Blood Pressure
As time passes, more states are moving to legalize marijuana for medicinal purposes and other derivatives from the cannabis plant and that means more people across the U.S. are using cannabis-based products like CBD hemp oil to treat and reduce the effects of a wide range of ailments. CBD contains some incredibly unique properties, which all contribute to making it a very effective and in-demand alternative medication for patients worldwide.
Without a doubt, one of the primary benefits to consider when you use CBD to lower blood pressure is that it not only targets your hypertension, it also works to lower anxiety, relieve insomnia, and heal any pain you might have in your body. The average American who suffers from high blood pressure is usually prescribed a range of pharmaceuticals to overcome the multitude of symptoms that come with hypertension. And over time all of these toxic medicines can have negative consequences to their overall health, so this is the primary driving force behind people turning to CBD for their health issues, as it naturally heals all aspects of hypertension.
CBD specifically lowers high blood pressure in two primary ways:
It Has Anti-Inflammatory Properties
When a part of your body becomes swollen and painful, it is referred to as inflammation. Hypertension can cause inflammation and in turn, inflammation causes hypertension. Many patients battling hypertension find that they also have to deal with inflammation and pain on an almost daily basis. CBD is an entirely natural anti-inflammatory, which helps eliminate and soothe any swelling you might have, so by healing your inflammation CBD also causes your blood pressure to lower.
It Reduces Anxiety
Hypertension can often be caused by anxiety and stress and vice versa. Many people are surprised to learn that the reason they feel stressed and anxious is because of high blood pressure. CBD will take care of any anxiety issues by lowering your heart rate and keep you in a calmer state. When your stress levels drop, so does your blood pressure.
Ways to Take Cannabis
There are a variety of ways that you can consume CBD in order to experience its potency, including:
- Oils or tinctures
- CBD sprays
- Gummy sweets
- Tea
- Edibles
Thanks to a variety of ingestion methods, you can try each one until you find a method that suits you best.
Dosage
If you want to enjoy all of the positive benefits of CBD, then you will need to get your dosage right. Dosage is a very individual aspect of CBD, so sometimes what works for one person doesn't work for another. It is always recommended that you start with a smaller dose and increase it gradually if you feel you need to. You can also consult a holistic physician to get more clarity on the best dose for your needs.
Final Thoughts
Modern society is that it comprises a variety of aspects that result in many of us having busy lifestyles and we always seem to be rushing from A to B. If this culture continues in the same way, even more people will develop hypertension, which is why it is so important to understand all of your treatment options in advance. CBD can be an effective and non-damaging way to treat the symptoms of high blood pressure and gives patients more of a choice with regards to moving forward with treatment.
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