Development of a Carotid Vulnerable Plaque Phantom Model Evaluated by Pixel Distribution Analysis

Carotid artery plaque composed of a larger percentage of lipids and/or intra-plaque hemorrhage are considered “vulnerable” or at higher risk for rupture. It is thought that such vulnerable lesions contribute to the majority of cardiovascular events. Ultrasound may facilitate the identification of plaque tissue types associated with risk for rupture. Pixel distribution analysis (PDA) is a plaque composition imaging analysis method that assigns grayscale ranges to corresponding tissue types. The aim of this study was to develop an in vitro vulnerable carotid plaque mimic (phantom) using known rat tissue types (fat, muscle and bone) to establish corresponding PDA ranges. Two sets of PDA grayscale ranges were established: (i) the combined tissue set, which combined tissue subtypes into their respective categories—polyvinyl chloride (representing blood, grayscale range 0–4), muscle (84–95), fat (99–113) and bone (145–175); (ii) Individual tissue set for each tissue subtype—polyvinyl chloride (grayscale range 0–4), neck muscle (68–86), leg muscle (76–86), epididymal fat (91–100), abdomen muscle (104-108), subcutaneous fat (111–120) and bone (145–175). The grayscale pixel range overlaped between tissue types (87–90 and 109–110). These ranges were tested on five simulated polyvinyl chloride heterogeneous plaque types containing epididymal fat, leg muscle, neck muscle, abdominal muscle or bone. The individual tissue set grayscale ranges detected significantly more pixels within the correct tissue category than the combined tissue set ranges (≤10.1%, p < 0.05). This study represents a novel phantom PDA method to assess plaque heterogeneity and may be used to infer tissue type composition in clinical imaging. Additionally, this plaque phantom may serve as a platform for development and testing of novel composition analysis methods.     

Effect of piperine on bioavailability and pharmacokinetics of propranolol and theophylline in healthy volunteers

Summary The effect of piperine on the bioavailability and pharmacokinetics of propranolol and theophylline has been examined in a crossover study. Six subjects in each group received a single oral dose of propranolol 40 mg or theophylline (150 mg) alone or in combination with piperine 20 mg daily for 7 days. An earlier t_max and a higher C_max and AUC were observed in the subjects who received piperine and propranolol. It produced a higher C_max, longer elimination half-life and a higher AUC with theophylline.In clinical practice, the enhanced systemic availability of oral propranolol and theophylline could be exploited to achieve better therapeutic control and improved patient compliance.     

The importance of age in allocating health care resources: does intervention‐type matter?

BACKGROUND: Recent proposals to reform cost-effectiveness analysis (CEA) by weighting health benefits [(Quality-adjusted life-years) QALYs] by recipients' age are based on studies examining age-related preferences in life-saving contexts. We investigated whether the perceived importance of age in resource allocation decisions differs among intervention-types. METHODS: 160 individuals were recruited from a cafeteria of a university medical centre and asked to choose between hypothetical health care programmes. Scenario A described two programmes treating life-threatening conditions and Scenario B two programmes providing palliative care. Programmes were identical except in average patient age (35 versus 65). Respondents also directly rated the importance of age for allocating resources for six types of interventions. RESULTS: Responses for the life-saving scenario favoured younger age groups while those for the palliative care scenario showed no age preference. The difference between scenarios was statistically significant. When directly rating the importance of age in allocating treatment resources, people placed greatest importance on age in treating infertility and life-saving, and least importance in treating depression. DISCUSSION: The importance people place on age as a resource allocation criterion depends on the clinical context. As QALYs serve as a common measure of health benefits for all intervention types, age weighting of QALYs is premature.     

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review

Coronavirus disease 2019 (COVID-19) is a global pandemic where several comorbidities have been shown to have a significant effect on mortality. Patients with diabetes mellitus (DM) have a higher mortality rate than non-DM patients if they get COVID-19. Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection. Additionally, patients without any history of diabetes can acquire new-onset DM when infected with COVID-19. Thus, there is a need to explore the bidirectional link between these two conditions, confirming the vicious loop between “DM/COVID-19”. This narrative review presents (1) the bidirectional association between the DM and COVID-19, (2) the manifestations of the DM/COVID-19 loop leading to cardiovascular disease, (3) an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop, (4) the role of vitamin-D in DM patients during COVID-19, and finally, (5) the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and “COVID-triggered DM” patients. We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events. Due to this alarming condition, early monitoring of atherosclerotic burden is required in “Diabetes patients during COVID-19” or “new-onset Diabetes triggered by COVID-19 in Non-Diabetes patients”.     

Need for a national epilepsy control program

This article briefly outlines the proposed national epilepsy control program. The content of the article is based on four meetings held by invitation of the Ministry of Health. Invitees by ministry – Drs. D. C. Jain, M. Gourie Devi, V. Saxena, S. Jain, P. Satish. Chandra, M. Gupta, K. Bala, V. Puri, K. S. Anand, S. Gulati, S. Johri, P. S. Chandra, M. Behari, K. Radhakrishnan, D. Bachani. Presentations were made by Dr. M. Tripathi.The program will involve all neurologists across the country in teaching and training at state levels and a central monitoring committee.