Inflammation and dyslipidaemia: a possible interplay between established risk factors in North Indian males with coronary artery disease

Objectives

Coronary artery disease (CAD) is a leading cause of morbidity and mortality in the developed world and is rapidly assuming epidemic proportions in developing countries, including India. This has led to extensive research to determine the risk factors and the pathways that may predispose to the elevated risk of this disease. Important among them include lipoproteins, homocysteine, lipoprotein (a), pro-inflammatory cytokines and others. The following study was undertaken to determine a possible inter-relationship between inflammation and dyslipidaemia, which are important risk factors for CAD in the atherosclerosis-prone North Indian male population.

Methods

The study groups comprised 150 clinically assessed North Indian male patients with acute myocardial infarction (AMI), diagnosed on electrocardiographic and biochemical criteria, and 150 healthy controls. Apolipoprotein-AI (Apo-AI), apolipoprotein-B (Apo-B) and C-reactive protein (CRP) levels were estimated using kits based on the immunoturbidimetric assay from Randox, UK. Tumour necrosis factor-α (TNF-α) and lipoprotein (a) were assayed using commercially available ELISA kits from Diaclone Research, Belgium and Innogenetics, Belgium, respectively.

Results

The patients with AMI showed highly significant elevations in the levels of total serum cholesterol, triglycerides, LDL cholesterol, Apo-B and a significant decline in HDL cholesterol, compared with healthy controls. Significantly elevated serum levels of inflammatory markers, TNF-α and CRP were seen in patients with AMI, compared to the control subjects. A significantly positive correlation of TNF-α was observed with lipoprotein (a) in patients with CAD.

Conclusion

The data clearly underlines a possible interplay between inflammation and dyslipidaemia in the pathogenesis of CAD in the Indian context. This insight into the aetiopathogenesis of CAD will prove highly beneficial for devising better preventive measures and pharmacological interventions for CAD.     

Videoendoscopic rehabilitation of iatrogenous Stensen-duct-acquired atresia in a patient with ring chromosome 21 syndrome and drooling

Drooling generally arises as a result of neurologic or muscular impairments, especially in subjects affected by cerebral palsies. It has never previously been described in patients with ring chromosome 21 syndrome. We describe the video-assisted surgical rehabilitation of the left parotid duct in a child with ring chromosome 21 syndrome and a persistent and painful swelling of the left parotid region after the surgical ligation of the Stensen ducts because of drooling. The diagnosis of Stensen duct dilatation as a result of iatrogenous complete distal acquired atresia was made by means of clinical and magnetic resonance evaluations. Video-assisted sialoendoscopical surgical rehabilitation of the left parotid duct was successfully performed; based on this experience, this minimally invasive procedure is preferred before traditional invasive parotid surgery in these cases. Other therapeutical options such as botulinum toxin therapy might be considered for the management of drooling in such young patients.     

Implant surface roughness influences osteoclast proliferation and differentiation

The osteoclast is a hematopoietic cell derived from CFU-GM and branches from the monocyte-macrophage lineage during the differentiation process. Biological environment appears to be crucial for osteoclast formation and activity. It has been reported that bone remodeling following implant placement requires a coordinated activity by osteoclasts and osteoblasts. The response of such cells at the bone-implant interface has been suggested to be affected by the structural and morphological features of the biomaterial surface. To shed more light on this topic we performed a multiparametric analysis of murine monocytes response to different titanium surfaces. These cells, RAW 264.7 type TIB-71, represent a very useful system because they differentiate into osteoclasts following treatment of definite doses of the osteoclast-differentiation factor RANKL and macrophage colony-stimulating factor (M-CSF). Cells, cultured on glass (control), on grade 3 machined and on titanium pull-spray superficial-TPSS surfaces disclosed profound different responses in terms of morphological rearrangements, adhesion, and differentiation abilities. Indeed, after 14 days, cells cultured on glass and machined surfaces were uniformly distributed, while, on the TPSS surface cells strictly aggregated into small isolated clusters were observed. In addition, cells cultured on the machined surface displayed a higher adhesion ability, while cells cultured on the rougher surface disclosed a more evident capability to differentiate. These results could explain the higher bone-implant contact percentage found around implants with rougher surfaces and suggest that osteoclasts may play an important role in the initial period after implant placement to prime or prepare the implant surface for the osteoblast activity.     

Clinical and socio-economic impact of influenza and respiratory syncytial virus infection on healthy children and their households

This prospective study compared the clinical and socio-economic impact of laboratory-confirmed influenza and respiratory syncytial virus (RSV) infection on healthy children and their families. Among 1,520 otherwise healthy children aged< 15 years attending the Emergency Department for acute conditions other than trauma, influenza viruses and RSV were found in 234 (15.4%) and 116 (7.6%; p<0.0001) patients, respectively. The fact that influenza has a similar global clinical impact on the community to that of RSV infection, but represents a greater socio-economic burden, may contribute to broadening the acceptance of influenza vaccination.