Vascular effects of TZDs: new implications

The incidence of diabetes, now affecting more than 170 million individuals is growing rapidly. Type 2 diabetes, which accounts for 90% of all diabetes cases, is associated with increased cardiovascular morbidity and mortality. Thiazolidinediones (TZDs), used for the treatment of patients with type 2 diabetes improve insulin sensitivity and endothelial dysfunction and exert beneficial effects on the lipid profile by activating the peroxisome proliferator-activated receptor gamma (PPAR-gamma). Moreover, a large body of evidence indicates that TZDs exhibit antiatherogenic effects independent of their antidiabetic and lipid-lowering properties by modulating inflammatory processes. This review will focus on the role of PPAR-gamma agonists in the vessel wall and summarize their effects on C-reactive protein (CRP), plasminogen activator inhibitor type-1 (PAI-1), matrix metalloproteinase-9 (MMP-9), adiponectin and ATP-binding cassette transporter A1 (ABCA1) and their implications for treatment of advanced stages of atherosclerosis, particularly in a setting of type 2 diabetes.     

Oral stereognostic ability: a test of oral perception

Oral stereognosis (form or shape recognition in the oral cavity) can be utilized to assess oral perceptual abilities. This assessment can be beneficial in planning as well as predicting the future outcome of any treatment modality in the orodental region. This article provides a meta analysis of different studies conducted in the last fifty years to quantify magnitude of oral sensory capacity using oral stereognostic ability tests and their implication in clinical dental sciences.     

Effect of pioglitazone on metabolic syndrome risk factors: results of double-blind, multicenter, randomized clinical trials

OBJECTIVE: To evaluate the effect of pioglitazone, metformin, and/or sulfonylurea on metabolic syndrome and its component parameters after a year of treatment. METHODS: Adult patients with poorly controlled type 2 diabetes were enrolled in 4 multicenter, double-blind studies and received pioglitazone, sulfonylurea, metformin, or a combination of any 2 agents. Post hoc analyses were performed on data from patients with evaluations at baseline and week 52, and treatment groups were compared to determine change from baseline in metabolic syndrome status and its component variables by using the McNemar test and analysis of covariance, respectively. RESULTS: Most patients (72.1%) had metabolic syndrome at baseline. Change in the proportion of patients with metabolic syndrome status was significant in each monotherapy and the pioglitazone plus metformin combination groups. Pioglitazone alone or in combination with metformin resulted in a significantly greater percent decrease from baseline in triglycerides (pioglitazone vs. metformin, 10.3%; pioglitazone vs. sulfonylurea, 6.5%; pioglitazone plus metformin vs. sulfonylurea plus metformin, 13.4%; P < 0.05) and a greater percent increase from baseline in high-density lipoprotein (HDL) cholesterol (pioglitazone vs. metformin, 9.1%; pioglitazone vs. sulfonylurea, 12.6%; pioglitazone plus metformin vs. sulfonylurea plus metformin, 17.8%; P < 0.001) at week 52 than did the respective comparison groups. A significant decrease from baseline in the ratio of urinary albumin to creatinine was found only with pioglitazone monotherapy (-1.764 mg/ mmol; P < 0.001), which was significantly greater than the change in the metformin monotherapy group (2.1%; P < 0.05). Significant decrease in blood pressure was observed in the pioglitazone monotherapy and pioglitazone plus sulfonylurea groups, with no significant treatment group differences. CONCLUSIONS: Treatment with pioglitazone as monotherapy or combination therapy led to sustained, positive effects on important components of metabolic syndrome in patients with type 2 diabetes, independent of effects on blood glucose control and, as such, could be translated to potential for reducing the risk of cardiovascular disease.     

Intralenticular opacification of hydrophilic acrylic intraocular lenses

PURPOSE: To find out the incidence of intraocular lens (IOL) optic opacification in a suspect IOL. METHODS: Retrospective review of patients' notes 3-4 years postimplant. RESULTS: In all, 56 IOLs showed signs of opacification, resulting in reduced vision out of 181 lenses traced. CONCLUSION: Certain hydrophilic acrylic IOLs like the model in question (SC60B-0UV) show opacification of the IOL, which may impair the vision of pseudophakic patients. However, not all lenses of this variety exhibit this cloudiness. Factors affecting this phenomenon are not yet completely clear but may include changes in the UV absorbant material incorporated in the lens substance itself. We report a series of patients who had received this lens and experienced loss of vision due to opacification of the IOL. In a follow-up ranging from 1 to 4 years postoperatively, a higher incidence of postoperative opacification of this lens emerges, after comparison with existing literature. IOL exchange in such patients is the only option. However, this mode of treatment should not be offered lightly as results may be guarded at best even in the face of a technically satisfactory procedure.     

Glaucoma monitoring in patients with a 'pseudophakic cataract'

PURPOSE: To assess potential problems in monitoring glaucoma status in pseudophakic patients in whom the intraocular lens (IOL) has undergone varying degrees of opacification. METHODS: Data was collected by retrospective review of the notes of such patients, who had received a hydrophilic acrylic IOL, SC-60B-0UV, after primary cataract extraction by phacoemulsification. At first, among these, patients with glaucoma were identified and notes were reviewed to identify problems with patients in whom the IOL had undergone varying degrees of opacification. RESULTS: A total of 32 eyes with glaucoma were identified to have received the SC-60B-0UV IOL. Of these, 13 IOLs (40.6%) had undergone varying degrees of opacification. Eyes with the opacified IOLs showed decreased visual acuity (2.5 lines of Snellen acuity on average). For these eyes, visual field performance (as determined on automated field analyzers) and optic disc assessments were adversely affected giving a false impression of advanced glaucomatous field loss. CONCLUSION: In our experience, glaucoma monitoring is made comparatively more difficult in pseudophakic patients with cloudy IOLs. Problems are encountered during assessment of the glaucomatous optic disc due to poor view of the optic disc. On standard static automated visual fields, these opacified IOLs produce artefactual visual field defects making monitoring glaucoma and subsequent management more difficult.     

Relapse of giant cell myocarditis supported with veno-arterial extracorporeal membrane oxygenation

Giant cell myocarditis (GCM) is a fatal form of myocarditis that often presents with acute heart failure. An inflammatory infiltrate with giant cells and myocardial necrosis is characteristic. During the acute presentation, mechanical circulatory support may be necessary for hemodynamic support while immunosuppression is initiated. We report a case of GCM relapse which was supported with veno-arterial membrane oxygenation until recovery. The patient is doing well one year after explantation.     

Live/real time three-dimensional transthoracic echocardiographic assessment of mycotic pseudoaneurysm involving the descending thoracic aorta

We describe a patient in whom a mycotic aneurysm involving the distal descending thoracic aorta could be definitively diagnosed by live/real time three-dimensional transthoracic echocardiography.     

Incremental value of live/real time three-dimensional transthoracic echocardiography in the assessment of left ventricular thrombi

This is a case series on three adult patients who contain left ventricular (LV) thrombus and the incremental benefits of live/real time three-dimensional transthoracic echocardiography (3DTTE) in comparison to two-dimensional transthoracic echocardiography (2DTTE) in evaluating LV thrombi. These cases illustrate that 3DTTE is of additional benefit by demonstrating the following: (1) cropping of a single 3DTTE apical dataset may be enough to provide comprehensive assessment of the LV in a timely manner even without breath holding in a not fully cooperative patient (2) it identifies the exact point of attachment of the thrombus to the left ventricular wall, (3) helps to delineate the absence or presence of focal echolucent areas within thrombi indicative of the presence and extent of clot lysis, which may have potential therapeutic and prognostic implications, and (4) provides more accurate assessment of thrombus mobility which has prognostic indications.     

Vicarin,a new isoflavone from Eremostachys vicaryi

Vicarin (1), a new isoflavone, has been isolated from the ethyl acetate-soluble fraction of the ethanolic extract of Eremostachys vicaryi, along with soforanarin B (2), luteolin 7-O-β-d-glucopyranoside (3), and hamighriprasin (4). Their structures were elucidated on the basis of their spectral data including MS and 2D NMR.