Title: Novel Strategies to Encounter Inflammation and ER Stress in Coronary Artery Disease
Atherosclerosis is the underlying cause of coronary artery disease (CAD) and a disease of multifactorial etiology. Recent investigations in atherosclerosis have been focused on inflammation and endoplasmic reticulum (ER) stress, providing new insights into the mechanism of the disease. Keeping in view the multifactorial aspects of this disease, novel strategies are urgently needed not only for identification of novel biomarkers, but also to search for remedies for prevention and treatment of this disease. C-reactive protein (CRP) is reported to be a biomarker of inflammation in CAD and is shown to actively contribute to the disease pathology. Our data from in vitro studies provided substantial evidence that MMP-TIMP and RAGE-EN-RAGE interactions significantly contribute to the pathophysiology of coronary artery disease. CRP was found to play a potential role in the induction, amplification, and prolongation of inflammatory response in atherosclerosis via modulating these genes and atorvastatin showed the potential to curb the deleterious effects of CRP. However, it is evident that besides use of several drugs like statins, inflammation persists in CAD patients. Therefore, we conducted studies with Terminalia arjuna (TA), a medicinal plant with a wide variety of applications in traditional medicine and referred to as a cardiotonic in Ayurvedic system of medicine. Evidence in literature demonstrates that TA like atorvastatin possesses pleotropic properties. Studies carried out in our laboratory have clearly demonstrated its anti-inflammatory and antithrombotic properties both in vitro as well as in vivo and in experimental animals. Expression of inflammatory genes eg. was found to be significantly reduced in vitro in a dose and time-dependent manner by Terminalia arjuna. Using a Systems Biology approach, observations of the in vitro study were further validated in a randomized, placebo-controlled, double-blind clinical trial in subjects with stable CAD who received either placebo or T. arjuna (500 mg twice a day; Himalaya) and were followed up to 6 months. TA was shown to attenuate inflammation and played a pivotal role in modulation of both cellular and humoral immunity. Chronic ER stress is implicated in the pathophysiology of atherosclerosis and is found to be associated with apoptosis. Research work in our lab demonstrated that TA specifically targeted early foam cell apoptosis via activation of unfolded protein response pathway. The data from our studies suggests use of a multipronged approach using novel therapies in terms of combination/ adjuvant therapy in clinical studies utilizing indigenous resources of medicinal plants to prevent/treat complex disorders such as CAD.
Veena Dhawan has completed her PhD from PGIMER and did post-doctoral research at minneapolis USA and post-graduate institute of medical education and research, chandigarh, India. At present, she is working as a professor in the department of experimental medicine and biotechnology at PGIMER a national institute of repute. She has published around 90 papers in reputed journals and written around seven book chapters.
Title: Iron deficiency anemia in children
Iron deficiency anemia in children
The purpose of the study: Was children with iron deficiency anemia and risk factors that may have affected children compared to non-anemic.
The Material & Methods: In this study are included 343 children; 244 children in the anemic study group and 99 children non-anemic in the control group.
Results: The result indicated that the children diagnosed with iron deficiency anemia consist more of male 57.4% compared to female 42.6% but they have no difference in the statistical significance. The age of these children consisted of approximately 19.2 months old (DS±13.7 months). Anemic children consisting of 62.2% were more often living in the city compared to those of controlling group by 52.5%; this difference had important statistical significance. The average mass of the child of birth body of the study group was 2973.5 gr while those of control group were 3405.7 gr. So, the average mass of the child of birth body of the study group (anemic) was significantly lower compared to children of the control group, which difference was statistically significant. Also, when involved in the study the average mass of the child of birth body of anemic children was much lower compared to the children of control group (difference was statistically significant.) Malnutrition was common in anemic children. Hypotrophy of the first instance was 36.5% and the second degree of hypotrophy was 6.6% of children of the study group. More than half (57.8%) of anemic children are fed with formula milk; 10.7% with commercial milk and 15.6% with natural milk or (cow milk). In 7.8% of cases they have mixed commercial with the formula milk or cow's milk and only one case was of commercial milk with cow's milk. Children of anemic group were less fed with meat, spinach, eggs; they were more fed with cereals compared with the children of control group; the difference consisted statistically significant. The average age of onset of artificial nutrition of children in the study group was 5.0 months; to children in the control group was 4.0 months without any statistically significance difference. Anemic children have started complementary food earlier than control group children with significant difference, which means that they are fed less exclusively breastfeeding and complementary feeding has started if not fed properly. Anemic children in the highest structure of anemic had their mothers anemic as well consisted of 47.1% compared with non-anemic children (27.3%) which difference was statistically significant. Bleeding during childbirth in similar structure of anemic children had mothers from (17.6%) and non-anemic from (18.2%) regardless statistically significant. Children of the study group were more often premature (14.3%) compared to those of control group (5.1%). They often resulted with lower body mass when in birth 29.1% versus 7.1%. More often twins 5.7% compared to those of control group 2.0%. To the anemic children we experienced a decrease in the number of erythrocytes, hemoglobin, MCV, hematocrit, and iron which was approximately 6.2 15.8 compared to the control group.
Conclusion: : From our data it is obvious that iron deficiency anemia is very often disease with many risk factors that can cause disease, as are the nutritional status and other diseases.
The deficit of iron and anemia iron are considered as major problems of public health and lack of the most common nutritional worldwide due to their high prevalence, effective on growth and development, resistance to infections and linkage to mortality of less than two year babies. In Kosovo, we have no correct statistics on national level for the prevalence of iron deficiency anemia.
Title: Pediatric obesity an emergency crisis
Pediatric obesity an emergency crisis
Pediatric obesity has rapidly become one of the leading international public health challenges. Since the 1980s, rates have more than doubled for preschool-aged children (2 to 5 years) and adolescents (12 to 19 years) and have more than tripled for school-aged children (aged 6-11 years) in the United States. Childhood obesity is an issue of serious medical and social concern. In developing countries, it is a phenomenon seen in higher socioeconomic strata due to the adoption of a western lifestyle. Consumption of high calorie food, lack of physical activity and increased screen time are major risk factors for childhood obesity apart from other genetic, prenatal factors and socio-cultural practices. Obese children and adolescents are at increased risk of medical and psychological complications. Insulin resistance is commonly present especially in those with central obesity and manifests as dyslipidemia, type-2 diabetes mellitus, impaired glucose tolerance, hypertension, polycystic ovarian syndrome and metabolic syndrome. Obese children and adolescents often present to general physicians for management. The latter play a key role in prevention and treatment of obesity as it involves lifestyle modification of the entire family. This article aims at discussing the approach to diagnosis and work-up, treatment and preventive strategies for childhood obesity from a general physician's perspective.
Ahmed Mohamed Abdelaal has completed his graduation (M.B.B.S) from the Al zagazig university, Egypt in 1989. He then acquired his Masters in Pediatrics (M.S) and his Doctorate in Medicine (M.D) in 1994 and 2006 respectively from the same university. He is also certified in Advanced Pediatric Life Support (APLS) and Advanced Cardiac Life Support (ACLS), postgraduate in pediatric nutrition PGEN (Boston University) and ENS (Munich University). Dr. Ahmed has more than 25 years of experience in General Pediatrics with a special interest in Pediatric Hematology and have a good experience in pediatric asthma.
Title: Foreign body aspiration: An important cause of medley acute and chronic respiratory symptoms in children and its management by flexible bronchoscopy
Foreign body aspiration: An important cause of medley acute and chronic respiratory symptoms in children and its management by flexible bronchoscopy
Introduction: Foreign body (FB) aspiration in airway is a common occurrence in pediatric age group, need prompt recognition and management. However, it is not always diagnosed (especially in radiolucent FB) due to non-specific symptoms of varying severity. Often the symptoms are subtle and mistaken for other more common conditions like pneumonia and asthma and do not respond as expected to standard therapy and present a diagnostic challenge. Rigid bronchoscopy still remains the gold standard in Bangladesh to remove airway FBs.
Aim: The main aim of this study was to emphasize the importance of considering airway foreign body as a cause of acute and chronic respiratory symptoms in children and to outline the clinical evidences of the utility and feasibility of flexible bronchoscopy for management of airway FB in children.
Methods: This prospective study was performed on children (aged six months to 16 year) having acute or recurrent or long standing, non-resolving or partially resolving respiratory complaints who underwent flexible bronchoscopy for suspected FB from July 2018 to July 2019 in a tertiary care hospital in Bangladesh. History, clinical, radiological, bronchoscopic ﬁndings and immediate effect after bronchoscopy were analyzed.
Results: The results indicated that among total 32 children, only 25% (n=8) had definite history of FB aspiration. The most frequent symptom was paroxysmal cough (72.7%) followed by wheezing, stridor and recurrent and persistent pneumonia. FB was found in 47% (n=15) children and removed successfully by Dormia basket in nine children, four by rat-tooth forceps and two by cryo probe. The most common (n=8) FB was peanut. Others are pin, metallic clip, plastic bead of Tasbih, filament of pencil torch light, custard apple seed, pea pulse, plastic safety ware joint. Thick mucus plugs were found in four children. Respiratory symptoms improved after removal of foreign bodies in all cases. Respiratory symptoms improved after removal of foreign bodies in all cases. During procedure, transient hypoxia developed in three children which were alleviated by temporary cessation of the procedure.
Conclusions: The possibility of foreign body aspiration should be considered in any child who present with acute or persistent and recurrent respiratory symptoms. And flexible bronchoscopy documented a crucial diagnostic and safe therapeutic tool for foreign body management in pediatric age group.
Sarabon Tahura is a medical graduate (MBBS) from mymensing medical college under dhaka university and has obtained her professional degree FCPS (Paediatrics) from bangladesh college of physicians and surgeon (BCPS). Afterwards, she has completed fellowship in paediatric intervention pulmonology from qilu children hospital under shangdong university, china and training from All india Institute of medical science (AIIMS). She is the associate professor of pediatric respiratory medicine and the 1st pediatric interventional pulmonologist of bangladesh. She is experienced in teaching and conducting post-graduation examinations of pediatrics in bangladesh. She has been published many articles under her name in different national and international journals and has been serving as an editorial board member of repute.