The effect of lower body weight support on arterial wave reflection in healthy adults.

Body weight support (WS) during treadmill exercise is used to rehabilitate orthopedic/neurological patients. WS lowers musculoskeletal strain and load. It compresses the lower body and increases intrathoracic volume. We studied short-term effects of WS on wave reflection indices using applanation tonometry during progressive WS of 25%, 50%, and 75% of body weight in 25 healthy men. WS decreased mean heart rate from 79 to 69 beats/min (P < .001). Peripheral and central mean arterial, systolic, and pulse pressures (PP) remained unchanged. There was a trend toward lower peripheral and central diastolic pressure. PP amplification ratio decreased significantly (P = .005). Reflected wave characteristics: Augmented pressure and index increased in a stepwise manner with WS (both P < .001). Both ejection duration and systolic duration of the reflected pressure wave (Ätr) increased progressively (both P < .001). The round-trip travel time (Δtp) was unchanged. Left ventricular workload and oxygen demand: Left ventricular wasted pressure energy increased (P < .001), and the subendocardial viability ratio decreased (P = .005), whereas the tension time index remained unchanged. In normal men, WS acutely decreases the PP amplification ratio, increases the amplitude and duration of the reflected aortic pressure wave, and increases measures of wasted left ventricular pressure energy and oxygen demand.

Psoas abscess secondary to Pott's disease--an unusual presentation in a young child.

Psoas abscess in neonates and infants are rare. Primary psoas abscesses are said to be more common in young children. Limping, fever and abdominal pain has been described to be the way psoas abscesses usually present. The authors describe the unusual presentation and successful treatment of a young child with a unilateral psoas abscess secondary to advanced spondylodiscitis.

Cardiovascular health knowledge and behavior in patient attendants at four tertiary care hospitals in Pakistan--a cause for concern.

BACKGROUND: Knowledge about coronary heart disease (CHD) and its risk factors is an important pre-requisite for an individual to implement behavioral changes leading towards CHD prevention. There is scant data on the status of knowledge about CHD in the general population of Pakistan. The objective of this study was to assess knowledge of CHD in a broad Pakistani population and identify the factors associated with knowledge. METHODS: Cross sectional study was carried out at four tertiary care hospitals in Pakistan using convenience sampling. Standard questionnaire was used to interview 792 patient attendants (persons accompanying patients). Knowledge was computed as a continuous variable based on correct answers to fifteen questions. Multivariable linear regression was conducted to determine the factors independently associated with knowledge. RESULTS: The mean age was 38.1 (+/- 13) years. 27.1% had received no formal education. The median knowledge score was 3.0 out of a possible maximum of 15. Only 14% were able to correctly describe CHD as a condition involving limitation in blood flow to the heart. Majority of respondents could identify only up to two risk factors for CHD. Most commonly identified risk factors were stress (43.4%), dietary fat (39.1%), smoking (31.9%) and lack of exercise (17.4%). About 20% were not able to identify even a single risk factor for CHD. Factors significantly associated with knowledge included age (p = 0.023), income (p < 0.001), education level (p < 0.001), residence (p < 0.001), a family history of CHD (p < 0.001) and a past history of diabetes (p = 0.004). Preventive practices were significantly lacking; 35%, 65.3% and 84.6% had never undergone assessment of blood pressure, glucose or cholesterol respectively. Only a minority felt that they would modify their diet, stop smoking or start exercising if a family member was to develop CHD. CONCLUSION: This is the first study assessing the state of CHD knowledge in a relatively diverse non-patient population in Pakistan. There are striking gaps in knowledge about CHD, its risk factors and symptoms. These translate to inadequate preventive behavior patterns. Educational programs are urgently required to improve the level of understanding of CHD in the Pakistani population.

G-protein beta-3 subunit gene 825C>T dimorphism is associated with left ventricular hypertrophy but not essential hypertension.

BACKGROUND: The human G-protein beta 3 subunit gene (GNB3) and some of its variants are known to be important genetic influences involved in essential hypertension (EH). Left ventricular hypertrophy (LVH) has long been thought to be an end point of EH, rather than a separate entity, though it is influenced by a unique set of hormonal, vascular and genetic factors. METHODS/MATERIALS: We carried out a retrospective, case-control study of a GNB3 825 C>T dimorphism among nationals from the United Arab Emirates (Emirati), an ethnic group characterized by no alcohol intake and no cigarette smoking, for putative correlations with EH and LVH. We investigated a sample population of 454 Emirati (231 men, 223 women) comprising groups of controls and patients with clinical diagnoses of LVH, based on echocardiographic and ECG criteria, and EH, based on blood pressure values. The GNB3 825 C>T genotypes were determined by PCR and restriction digestion. RESULTS: The distribution of genotypes was in Hardy-Weinberg equilibrium in all three subject groups. GNB3 T825 alleles demonstrated a strong association with LVH (OR = 2.22; 95% CI: 1.29-3.83 and P = 0.0002), but not with EH. CONCLUSIONS: GNB3 825 C>T is likely to be a significant risk factor for LVH but not for EH in the Emirati population, thereby strengthening the view that LVH is genetically a separate clinical entity.