Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review.

BACKGROUND: Coronary Artery Disease (CAD) is the foremost single cause of mortality and loss of Disability Adjusted Life Years (DALYs) globally. A large percentage of this burden is found in low and middle income countries. This accounts for nearly 7 million deaths and 129 million DALYs annually and is a huge global economic burden. OBJECTIVE: To review epidemiological data of coronary artery disease and acute coronary syndrome in low, middle and high income countries. METHODS: Keyword searches of Medline, ISI, IBSS and Google Scholar databases. Manual search of other relevant journals and reference lists of primary articles. RESULTS: Review of the results of studies reveals the absolute global and regional trends of the CAD and the importance and contribution of CAD for global health. Data demonstrates which region or countries have the highest and lowest age-standardized DALY rates and what factors might explain these patterns. Results also show differences among the determinants of CAD, government policies, clinical practice and public health measures across the various regions of world. CONCLUSION: CAD mortality and prevalence vary among countries. Estimation of the true prevalence of CAD in the population is complex. A significant number of countries have not provided data, the estimation of the exact figures for epidemiological data is a barrier. The incidence of CAD continues to fall in developed countries over the last few decades and this may be due to both effective treatment of the acute phase and improved primary and secondary preventive measures. Developing countries show considerable variability in the incidence of CAD. The globalization of the Western diet and increased sedentary lifestyle will have a dramatic influence on the progressive increase in the incidence of CAD in these countries.

Myasthenic crisis following iodinated contrast material (iohexol) aspiration: a case report.

BACKGROUND: The number of contrast media-related procedures is ever increasing due to the widespread availability of theoretically safe, low osmolar iodinated contrast material. Although intravenously administered contrast is known to precipitate myasthenic crisis, oral contrast aspiration as a causative factor is not yet documented as such. A 48-year-old Sinhalese man diagnosed as having myasthenia gravis, was evaluated for progressive dysphagia with an upper gastrointestinal contrast study. Iodinated contrast material (iohexol) was used as the contrast medium and there was direct evidence of contrast aspiration during the study. Several minutes after the procedure, severe respiratory distress with evidence of myasthenic crisis requiring intubation and intensive care admission was noted. Treatment with intravenous immunoglobulin, high-dose steroids, and broad-spectrum intravenously administered antibiotics led to an uneventful recovery, although the latter part of the clinical course was complicated with total left lung collapse. Myasthenic crisis can be precipitated by various factors and a successful recovery requires mechanical respiratory support with immunomodulatory and steroid therapy. This is the first reported case that describes the development of myasthenic crisis following iohexol-associated aspiration pneumonitis.

Post encephalitic parkinsonism following dengue viral infection.

BACKGROUND: Incidence of dengue fever as well as dengue hemorrhagic fever is increasing in Sri Lanka especially among elderly population. As the number of cases is rising, rare complications of dengue illness also can be seen in clinical practice when compared to the past few years. Prompt identification and treatment of such complications is challenging due to lack of awareness and unavailability of standard treatment. CASE PRESENTATION: 69 years old man presented with acute onset fever and was diagnosed as having dengue illness. On the 4th day of illness, the disease was progressed into dengue haemorrhagic fever and recovered uneventfully. Although he recovered from primary illness, his general condition continued to deteriorate due to new onset of features of parkinsonism. Cerebrospinal fluid analysis and electro encephalogram showed evidence of encephalitis. Cerebrospinal fluid analysis also revealed positive IgM antibodies against dengue virus. Then the diagnosis of post encephalitic parkinsonism following dengue viral infection was made and started on. He was started on SINEMET (carbidopa 10 mg and levodopa 100 mg) half tablet 6 hourly started. After 1 week of treatment he showed marked improvement and then patient was discharged with further follow up plan. CONCLUSION: Although the management of dengue illness and dengue haemorrhagic fever is straightforward, recognition and treatment of rare complications like post encephalitic parkinsonism following dengue viral infection is difficult without great clinical suspicion.

Aging and obesity are associated with undiagnosed hypertension in a cohort of males in the Central Province of Sri Lanka: a cross-sectional descriptive study.

BACKGROUND: Lifestyle factors associated with hypertension (HT) in South Asian populations are relatively unknown. The objective of the current study was to investigate the prevalence rates of undiagnosed HT and factors associated with it in a cohort of males from the Central Province of Sri Lanka. METHODS: The study group consisted of 2462 males (mean age 31 years, range: 16-72 years) who underwent a routine medical examination at the National Transport Medical Institute, Kandy, Sri Lanka. Participants with previously diagnosed heart disease, diabetes, hypertension or other chronic illnesses were excluded from this study. Dietary and other lifestyle factors were studied using validated self-administered questionnaires. Body Mass Index (BMI) cut-off values for Asians were used to categorize the subjects according to weight status. The association of individual dietary and lifestyle patterns with HT was assessed by fitting into binary logistic regression models. RESULTS: The mean systolic (SBP) and diastolic blood pressures (DBP) of the individuals were 125.9 mmHg and 80.5 mmHg, respectively. The prevalence rate of undiagnosed HT was 31.7%. Both SBP and DBP showed significant positive correlations with age, weight, BMI and waist circumference. After adjusting for potential confounders, HT was associated with older age (p = 0.001) and increased weight status (p < 0.001) with trends of association for level of education (p = 0.058). Level of income, alcohol consumption, sleeping hours, smoking, physical activity level, ethnic difference, consumption of fruits, fish, meat, dairy, sweets or fried snacks were not significantly associated with HT. Obese males were 92.1% [odds ratio: 1.9 (1.4-2.7)] more likely to be hypertensive compared to normal weight males. CONCLUSIONS: Undiagnosed HT is prevalent at an alarming rate among adult males in the Central Province of Sri Lanka. Its association with age and BMI (weight status) highlights the importance of routine screening for HT as well as interventions targeted at reducing obesity to curb the rise of this modifiable cardiovascular disease risk factor.

Lifestyle factors associated with obesity in a cohort of males in the central province of Sri Lanka: a cross-sectional descriptive study.

BACKGROUND: Obesity has become a global epidemic. The prevalence of obesity has also increased in the South Asian region in the last decade. However, dietary and lifestyle factors associated with obesity in Sri Lankan adults are unclear. The objective of the current study was to investigate the association of dietary and lifestyle patterns with overweight and obesity in a cohort of males from the Central Province of Sri Lanka. METHODS: A total of 2469 males aged between 16 and 72 years ([Formula: see text]) were included in the study. The sample comprised individuals who presented for a routine medical examination at the National Transport Medical Institute, Kandy, Sri Lanka. The Body Mass Index (BMI) cutoff values for Asians were used to categorize the participants into four groups as underweight, normal weight, overweight or obese. The data on dietary and lifestyle patterns such as level of physical activity, smoking, alcohol consumption, sleeping hours and other socio demographic data were obtained using validated self-administered questionnaires. Multinomial logistic regression model was fitted to assess the associations of individual lifestyle patterns with overweight and obesity. RESULTS: The mean BMI of the study group was 22.7 kg m-2 and prevalence rates of overweight and obesity were 31.8 and 12.3%, respectively. Mean waist circumference of the participants was 78.6 cm with 17.1% of them being centrally obese. After adjusting for potential confounders, weight status was associated with older age (P < 0.0001), ethnicity (P = 0.0033) and higher income (P = 0.0006). While higher physical activity showed a trend for being associated with lower odds of being obese (odds ratio: 0.898 - confidence interval: 0.744-1.084), alcohol intake, consumption of fruits, level of education, sleeping hours, smoking, consumption of fish, meat, dairy, sweets or fried snacks were not significantly associated with the weight status. CONCLUSION: The high prevalence rates of overweight and obesity in working-age males is a threatening sign for Sri Lanka. Since the prevalence rate is higher in certain ethnic groups and higher-income groups, targeted interventions for these groups may be necessary.