Dietary Fats and Oxidative Stress: A Cross-Sectional Study Among Coronary Artery Disease Subjects Consuming Coconut Oil/Sunflower Oil.

Coconut oil has been used by the people of Kerala as a cooking medium for several decades. Due to its alleged hypercholesterolemic activity, general population in recent times is shifting to cooking oils rich in polyunsaturated fats, the most popular being sunflower oil. The effect of long-term consumption of sunflower oil on oxidative stress in humans is not well investigated. We studied oxidative stress among coronary artery disease (CAD) patients who were consuming coconut oil or sunflower oil as a part of their routine diet. Men, aged 35-70 years, with established CAD, who presented to the hospital for routine cardiac evaluations, were enrolled in this observational study. Group 1 and 2 consisted of 73 and 80 subjects consuming coconut oil and sunflower oil respectively for over a period of 2 years. Lipid profile and parameters for oxidative stress were evaluated among them. Conventional lipid parameters did not differ significantly between the two groups. Mean vitamin C concentration was significantly reduced for subjects on sunflower oil compared to those consuming coconut oil (P = 0.044). Malondialdehyde was higher for sunflower oil consumers compared to coconut oil consumers (P < 0.0001). Other parameters such as oxidized LDL, GSH, GPx and SOD were not found to be significantly different between the two groups. The results of the present study show that coconut oil did not induce hypercholesterolemia compared to sunflower oil. On the other hand, sunflower oil group had elevated oxidative stress compared to coconut oil group.

Effectiveness of Ventricular Intrinsic Preference (VIP™) and Ventricular AutoCapture (VAC) algorithms in pacemaker patients: Results of the validate study.

BACKGROUND: Several past clinical studies have demonstrated that frequent and unnecessary right ventricular pacing in patients with sick sinus syndrome and compromised atrio-ventricular conduction (AVC) produces long-term adverse effects. The safety and efficacy of two pacemaker algorithms, Ventricular Intrinsic Preference™ (VIP) and Ventricular AutoCapture (VAC), were evaluated in a multi-center study in pacemaker patients. METHODS: We evaluated 80 patients across 10 centers in India. Patients were enrolled within 15 days of dual chamber pacemaker (DDDR) implantation, and within 45 days thereafter were classified to either a compromised AVC (cAVC) arm or an intact AVC (iAVC) arm based on intrinsic paced/sensed (AV/PV) delays. In each arm, patients were then randomized (1:1) into the following groups: VIP OFF and VAC OFF (Control group; CG), or VIP ON and VAC ON (Treatment Group; TG). Subsequently, the AV/PV delays in the CG groups were mandatorily programmed at 180/150 ms, and to up to 350 ms in the TG groups. The percentage of right ventricular pacing (%RVp) evaluated at 12-month post-implantation follow-ups were compared between the two groups in each arm. Additionally, in-clinic time required for collecting device data was compared between patients programmed with the automated AutoCapture algorithm activated (VAC ON) vs. the manually programmed method (VAC OFF). RESULTS: Patients randomized to the TG with the VIP algorithm activated exhibited a significantly lower %RVp at 12 months than those in the CG in both the cAVC arm (39±41% vs. 97±3%; p=0.0004) and the iAVC arm (15±25% vs. 68±39%; p=0.0067). In-clinic time required to collect device data was less in patients with the VAC algorithm activated. No device-related adverse events were reported during the year-long study period. CONCLUSIONS: In our study cohort, the use of the VIP algorithm significantly reduced the %RVp, while the VAC algorithm reduced in-clinic time needed to collect device data.

Elevated oxidative stress among coronary artery disease patients on statin therapy: A cross sectional study.

BACKGROUND: Statins are a major group of drugs that reduces LDL-C levels, which are proven to have other beneficial effects such as preventing coronary events. The objective of this study was to evaluate oxidative stress and select novel coronary artery disease risk factors among coronary artery disease patients on statins. METHODS: In this observational, cross-sectional study, we compared total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, apolipoprotein B, lipoprotein (a), homocysteine, reduced glutathione, glutathione peroxidase, superoxide dismutase, ascorbic acid, malondialdehyde and oxidized LDL among male coronary artery disease patients on statin therapy (group 2, n = 151) with sex-matched, diabetic patients (group 3, n = 80) as well as healthy controls (group 1, n = 84). RESULTS: Total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol were significantly lower among subjects of group 2 compared to other two groups. The novel risk factors studied did not differ significantly between groups, except for a higher homocysteine level among group 2 subjects compared to the other two groups. Elevated oxidative stress, indicated by lower reduced glutathione, glutathione peroxidase, and ascorbic acid as well as higher malondialdehyde and oxidized LDL was observed among group 2 subjects. Triglycerides, HDL-cholesterol, ascorbic acid and malondialdehyde were found to be independent predictors for coronary artery disease among this study population. CONCLUSIONS: Though coronary artery disease subjects had healthy lipid profile, oxidative stress, a recognized risk factor for coronary events, was still elevated among this patient group. Novel risk factors were not found to be major predictors for coronary artery disease among the study subjects.

Permanent pacing in a patient with tricuspid prosthesis--widening therapeutic use of coronary sinus.

Unconventional sites are being used for pacing in patients with inaccessible right ventricle like single ventricle, atresia of tricuspid valve and in anomalous venous drainage. Here we report a case in which the right ventricle could not be accessed due to the metallic prosthesis. A 41-year-old lady required triple valve replacement for rheumatic involvement. Permanent pacemaker implantation was done with epicardial lead for bradycardia post operatively. Pulse generator change was needed within 3 years as the pacemaker reached end of life due to high lead threshold. Subsequent pacemaker implantation was done with a left ventricular lead in coronary sinus by percutaneous approach. One year after implantation, the threshold remains stable. Coronary sinus can be utilized for permanent pacing in patients with inaccessible right ventricle due to prosthetic tricuspid valve.

Composition of plasma and atheromatous plaque among coronary artery disease subjects consuming coconut oil or sunflower oil as the cooking medium.

OBJECTIVES: Coconut oil, which is rich in medium-chain saturated fatty acids, is the principal cooking medium of the people of Kerala, India. Replacement of saturated fat with polyunsaturated fat is effective in reducing serum cholesterol levels. However, the effect of substituting coconut oil with sunflower oil on the fatty acid composition of plaque has not been thoroughly investigated. We therefore evaluated and compared the fatty acid composition of plasma and plaque among subjects consuming coconut oil or sunflower oil as the cooking medium. METHODS: Endarterectomy samples and plasma samples were obtained from subjects who underwent coronary artery bypass grafts (n = 71). The subjects were grouped based on the type of oil they were using as their cooking medium (coconut oil or sunflower oil). The fatty acid composition in the plaques and the plasma was determined by HPLC and the data were analyzed statistically. RESULTS: Sunflower oil consumers had elevated concentrations of linoleic acid (p = 0.001) in plasma, while coconut oil users had higher myristic acid levels (p = 0.011) in plasma. Medium-chain fatty acids did not differ significantly between the two groups in the plasma. Medium-chain fatty acids were detected in the plaques in both groups of subjects. In contrast to previous reports, long-chain saturated fatty acids dominated the lipid content of plaque in this population, and the fatty acid composition of plaque was not significantly different between the two groups. No correlation between fatty acids of plasma and plaque was observed in either group. CONCLUSION: A change in cooking medium, although it altered the plasma fatty acid composition, was not reflected in the plaque composition.

(E)-1-(4-Bromo-phen-yl)-3-(2-meth-oxy-phen-yl)prop-2-en-1-one.

In the title compound, C(16)H(13)BrO(2), the dihedral angle between the mean planes of the meth-oxy- and bromo-substituted benzene rings is 24.6 (1)°. The angles between the mean plane of the prop-2-en-1-one group and the 4-bromo-phenyl and 2-meth-oxy-phenyl ring planes are 18.8 (1) and 6.0 (1)°, respectively.

Effect of high fat diet without cholesterol supplementation on oxidative stress and lipid peroxidation in New Zealand white rabbits.

AIM: Dietary fats may affect coronary artery disease risk by influencing factors other than serum cholesterol. The effect of diets containing coconut oil and sunflower oil without cholesterol supplementation on oxidative stress and lipid peroxidation were studied in male New Zealand White rabbits. METHODS: Animals assigned to four groups (control, cholesterol-fed, coconut oil-fed and sunflower oil-fed), given an isocaloric diet and studied for 6 months. The lipid profile, reduced glutathione, glutathione peroxidase, superoxide dismutase, vitamin C and lipid peroxidation were evaluated at the beginning of the study, at the third month and at the end of the study period. RESULTS: Serum lipid values did not show significant variation between animals fed coconut oil and sunflower oil, but total cholesterol, triglycerides and LDL-cholesterol were significantly higher and HDL-cholesterol was reduced in cholesterol-fed animals. Lipid peroxidation was higher in cholesterol-fed and sunflower oil-fed rabbits compared to controls and coconut oil-fed rabbits. Though other parameters such as reduced glutathione, glutathione peroxidase, superoxide dismutase and ascorbate did not vary between the two oil-fed rabbit groups, cholesterol-fed rabbits showed severe oxidative stress. CONCLUSION: We conclude that in the absence of cholesterol supplementation, coconut oil intake up to 30% of daily energy supply did not cause hypercholesterolemia or oxidative stress in rabbits.

Comparison of lipid profile and antioxidant enzymes among south Indian men consuming coconut oil and sunflower oil.

In this study, we compared the lipid profile and antioxidant enzymes of normal and diabetic subjects consuming two different types of oil as cooking medium. 70 normal, healthy subjects were taken as controls and 70 subjects with Type 2 diabetes were recruited in patient group. Each group was further subdivided into two subgroups of 35 subjects each, consuming coconut oil and sunflower oil respectively as cooking medium. Samples of blood were collected and analyzed for serum total cholesterol, triacylglycerols, and cholesterol in lipoprotein fractions. Total glutathione and glutathione peroxidase were measured in erythrocytes and superoxide dismutase in serum. Triacylglycerols, LDL and VLDL cholesterol levels were high in the diabetic subjects compared to the controls. Total glutathione and glutathione peroxidase values showed significant decrease in diabetic subjects as compared to the controls, while superoxide dismutase values showed significant difference between coconut oil consuming groups. Though lipid profile parameters and oxidative stress were high in Type 2 diabetic subjects compared to controls, no pronounced changes for these parameters were observed between the subgroups (coconut oil vs. sunflower oil).

Caregiver burden in anxiety disorders.

PURPOSE OF REVIEW: Family burden research has primarily focused on severe mental disorders. Despite the high prevalence and chronic disabling nature of anxiety disorders, family burden has been relatively neglected in our understanding of their impact on caregivers. The paper reviews the available evidence on caregivers' burden in different anxiety disorders. FINDINGS: Obsessive-compulsive disorder and posttraumatic stress disorder are the only anxiety disorders that have been studied in this regard, while there is a significant lack of data about other anxiety disorders. Caregiver burden in obsessive-compulsive disorder is equivalent to that of severe mental disorders like schizophrenia and affective disorders. Spouses/partners and children experience a significant degree of burden in looking after their relatives with posttraumatic stress disorder. SUMMARY: Available limited data indicates an adverse impact on families looking after their relatives with anxiety disorders such as obsessive-compulsive disorder and posttraumatic stress disorder. There is an urgent need for further research to increase our understanding of family burden and, accordingly, to support families involved in the care of patients with anxiety disorders. The impact of caregiver burden on disease and recovery in anxiety disorders also needs to be addressed in future research.

Suicidal behavior in obsessive-compulsive disorder.

OBJECTIVE: There are limited data on suicidal behavior in obsessive-compulsive disorder (OCD). This study examines suicidal behavior and its clinical correlates in OCD subjects. METHOD: One hundred consecutive DSM-IV OCD subjects attending the specialty OCD clinic and the inpatient services of a major psychiatric hospital in India from November 1, 2003, to October 31, 2004, formed the sample of this study. Subjects were assessed systematically by using structured interviews and various rating scales. The Scale for Suicide Ideation-worst ever (lifetime) and -current measured suicidal ideation. The 24-item Hamilton Rating Scale for Depression (HAM-D) measured severity of depression, and the Beck Hopelessness Scale (BHS) measured hopelessness. We performed assessments at study entry. We employed binary logistic regression (Wald) forward stepwise analysis for prediction of suicidal ideation and suicide attempt, and we used structural equation modeling for identifying the potential factors contributing to suicidal ideation. RESULTS: The rates of suicidal ideation, worst ever and current, were 59% and 28%, respectively. History of suicide attempt was reported in 27% of the subjects. For past suicide attempt, worst ever suicidal ideation (p < .001) was the only significant predictor, with an overall prediction of 89%, and accounted for 60% of the variance. For worst ever suicidal ideation, major depression (p = .043), HAM-D score (p = .013), BHS score (p = .011), and history of attempt (p = .009) were significant predictors, with an overall prediction of 82% and variance of 56%. Somewhat similar predictors emerged as significant for current suicidal ideators, with an overall prediction of 85% and variance of 50%. In the structural equation model, too, presence of depression and high BHS score contributed to suicidal ideation. CONCLUSIONS: OCD is associated with a high risk for suicidal behavior. Depression and hopelessness are the major correlates of suicidal behavior. It is vital that patients with OCD undergo detailed assessment for suicide risk and associated depression. Aggressive treatment of depression may be warranted to modify the risk for suicide. Future studies should examine suicidal behavior in a prospective design in larger samples to examine if severity of OCD and treatment nonresponse contribute to suicide risk.

Bipolar and nonbipolar obsessive-compulsive disorder: a clinical exploration.

Comorbidity of obsessive-compulsive disorder (OCD) in bipolar disorder is well documented. However, clinical characteristics of bipolar OCD are not well studied. The objective of the present study was to compare the clinical characteristics of bipolar and nonbipolar OCD. We chose 28 subjects with bipolar-OCD comorbidity from a sample of 80 remitted bipolar subjects (bipolar OCD) attending the outpatient services of the National Institute of Mental Health and Neurosciences, Bangalore, India, over a period of 11 months. We also recruited 78 nonbipolar OCD subjects consecutively during the same period from the OCD clinic of the institute. They underwent systematic assessment using both structured and unstructured clinical interviews and corroborative information obtained from the immediate family members and the hospital clinical charts. Bipolar OCD subjects were characterized by episodic course of OCD, high family loading for mood disorders, and comorbidity with depression, social phobia, and generalized anxiety disorder. They had less severe OCD and had somewhat different symptom profile compared with nonbipolar OCD. The OCD predated bipolar disorder in 54% of the bipolar OCD subjects; and in the remaining subjects, it had an onset during the course of bipolar disorder. Most bipolar OCD subjects reported worsening of OCD in depression (n = 22, 78%) and improvement in manic/hypomanic episodes (n = 18, 64%). Our findings suggest that OCD in those with a primary diagnosis of bipolar disorder is perhaps pathophysiologically related to bipolar disorder than to OCD. This is strongly supported by the episodic course of OCD, high familial loading for mood disorders, and worsening of OCD in depression with improvement in hypomania/mania phases. There is a need for systematic exploration of the OCD-bipolar comorbidity in both OCD and bipolar samples. Family-genetic and other neurobiological research and the prospective follow-up of bipolar and nonbipolar OCD subjects would further enhance our understanding of this complex comorbidity. The cross-sectional nature of the study based on retrospective assessment of course, the small sample size and the inclusion of only remitted bipolar subjects are the limitations of this study.

Left ventricular posterior wall pseudoaneurysm: a rare sequela of mitral valve infective endocarditis in a chronic patient of HLA-B27 positive spondyloarthritis.

Left ventricular posterior wall pseudoaneurysm after native mitral valve infective endocarditis is a very rare occurrence. We report such a case in a patient with HLA-B27-associated spondyloarthritis and normal coronary arteries. Excision of the aneurysm with left ventricular reconstruction and mitral valve replacement resulted in an excellent outcome.

Stenting the patent arterial duct to increase pulmonary blood flow.

BACKGROUND: Use of surgically created aoropulmonary shunt is well-established for improving pulmonary blood flow in infants with critical reduction in pulmonary blood flow. Recently, stenting the patent ductus arteriosus has emerged as an alternative in selected infants with congenital heart disease and reduced pulmonary blood flow. METHODS AND RESULTS: We reviewed records of consecutive infants undergoing stenting of patent ductus arteriosus between August 2003 and October 2005 at our institution. Two of 12 patients underwent patent ductus arteriosus stenting to facilitate preparation of left ventricle for transposition with intact septum. We report the case selection, technique, immediate and short-term follow-up outcome in the remaining 10 patients [median age: 16 days (range 4-290 days): weight 2.7 kg (range 2-6 kg)] with reduced pulmonary blood flow who underwent stenting of patent ductus arteriosus as an alternative to conventional surgical aortopulmonary shunts. Five of the 6 newborns were prostaglandin-dependent and 4 had previously undergone guidewire perforation of the pulmonary valve (n=2) or balloon dilation (n=2). Successful stent implantation was accomplished in all with no major patient-related complication (median fluoroscopy time: 18.6 min; range: 7.7-72 min). The intensive care unit and hospital stays were prolonged in 3 patients because of sepsis (n=2) and pulmonary over-circulation with sepsis (n=1). On follow-up (median 5.5 months; range 1-19 months) all implanted stents were patent. One patient underwent re-dilation of the implanted stent for declining saturations. CONCLUSIONS: The immediate and short-term follow-up results of stenting of the patent arterial duct, as an alternative to the surgical aortopulmonary shunt in carefully selected newborns and infants is encouraging.

Neurovascular rescue for embolic stroke following atrial septal defect closure.

Strokes following cardiac surgery occur in about 5% of patients. Intra-arterial thrombolysis is a good option in such a setting where intravenous thrombolysis is contraindicated, and when in-hospital strokes are detected well within the window for treatment and the chances of complete reperfusion are maximum. On postoperative day 4 after atrial septal defect correction, a 34-year-old woman with paroxysmal atrial fibrillation developed left middle cerebral artery stroke causing severe neurological deficits. Intra-arterial thrombolysis with urokinase led to remarkable recovery.