Background: Atherosclerosis is an inflammatory disease of the blood vessel wall, characterized in early stages by endothelial dysfunction, recruitment and activation of monocyte/macrophages. Glimepiride is one of the third generation sulphonylurea drugs, useful for control of diabetes mellitus type two and it may exert anti inflammatory activity, by induction of nitric oxide production or through selective suppression of the cyclooxygenase pathway. Repaglinide is a new hypoglycemic agent, and a member of the carbamoylmethyl benzoic acid family. Some results from the literature demonstrate that repaglinide has favorable effects on the parameters of antioxidative balance. Objectives: The objective of the present study was to assess the effect of glimepiride and repaglinide on atherosclerosis via interfering with the inflammatory and oxidative pathways. Materials and Methods: Twenty four local domestic male rabbits were involved in this study. The animals were randomly divided into four groups; Group I rabbits fed normal chow (oxiod) diet for 10 weeks. Group II rabbits were fed with 1% cholesterol enriched diet. Group III rabbits were fed with 1% cholesterol enriched diet together with Glimepiride (0.1 mg/kg once daily before morning feed). Group IV rabbits were fed with 1% cholesterol enriched diet together with Repaglinide (0.3 mg/kg once daily before morning feed). Blood samples were collected before (0 time) and every two weeks of experimental diets for measurement of serum triglycerides (TG), total cholesterol (TC), High-density lipoprotein cholesterol (HDL-C), high sensitive C - reactive protein (hsCRP), Interleukin - 6 (IL-6) and Tumor Necrosis Factor alpha (TNF-α) levels. At the end of 10 weeks, the aorta was removed for measurement of aortic Malondialdehyde (MDA), reduced glutathione (GSH) and aortic intimal thickness. Results: Glimepiride and repaglinide treatment did show significant effect on lipid parameters compared with induced untreated group (P < 0.05). Also, they significantly reduced the elevation in hsCRP, IL-6, TNF-α, aortic MDA and aortic intimal thickness compared with induced untreated group (P < 0.05), and they helped to restore the aortic GSH levels (P < 0.05). Conclusions: Glimepiride and repaglinide may reduce atherosclerosis progression in hypercholesterolemic rabbits by interfering with the inflammatory and oxidative pathways without affecting lipid parameters.

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We report a case of an anomalous origin of a right coronary artery from the left coronary sinus with an inter-arterial course, between the aorta and the main pulmonary artery. This variant has been called malignant because of its association with sudden death, especially in young asymptomatic athletes. Although these variants are rare, knowledge of cross sectional anatomy of the coronary arteries and their variants is critical, especially because some variants are associated with sudden death.

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Pheochromocytomas have been described to be associated with rare vascular abnormalities, most common of them being renal artery stenosis. A 45-year-old woman was admitted to our hospital with complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and severe hypertension. Hypertension was confirmed to result from both excess catecholamine production and hyperreninemia of left kidney. The technical images (abdominal CT and renal arteriography) revealed the presence of a left adrenal pheochromocytoma and stenosis of the renal artery. Surgical removal of pheochromocytoma and correction of renal artery stenosis restored the postoperative plasma catecholamine, renin and blood pressure to normal. To our belief, this is the first such case report from India citing this rare association. We conclude that when the two diseases occur simultaneously, both must be diagnosed accurately and treated in a different manner. We also hereby review the existing literature.

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Rupture of the sinus of Valsalva (RSOV) is an uncommonly encountered condition. It can present with wider manifestations ranging from an asymptomatic murmur to cardiogenic shock. The case discussed in this report also had subaortic membrane which usually presents with subvalvular aortic stenosis, left ventricular hypertrophy, myocardial ischemia and sudden death. Corrective cardiac surgery was advised, but due to financial constraints, the patient could not be operated and he died. Here, the authors report for the first time an unusual presence of both RSOV and subaortic membrane and the patient presented with thromboembolic complication resulting from infective endocarditis.

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Context: Stentless aortic valve prostheses have excellent hemodynamic profiles, but may be associated with an increased postoperative heart block when compared to conventional prostheses. Aims: To assess the effect of an alternative subcoronary implantation technique on postoperative complete heart block (CHB) and permanent pacemaker implantation (PPI) following aortic valve replacement (AVR) with stentless tissue valves. Settings and Design: A total of 130 consecutive patients undergoing AVR with stentless tissue valves by a single surgeon were studied retrospectively. Materials and Methods: A stentless tissue valve was implanted into 80 patients using the conventional modified subcoronary implantation technique, and 50 patients received a stentless tissue valve by an alternative subcoronary technique in which the inflow suture line is raised at the level of right-non coronary commissure. Data were collected at the time of hospital discharge and at 6-12 months postoperatively. Statistical Analysis Used: Independent samples t-test was used to compare continuous variables, and categorical variables were compared with the chi-square test. Results: Use of this new method reduced postoperative CHB (4.0% vs. 16.3%, P = 0.033), with fewer patients requiring PPI in the early postoperative period (6.0% vs. 18.8%, P = 0.041). Echocardiographic examination showed no differences in the effective orifice area, peak and mean aortic valve gradients, or left ventricular mass index between groups. Trivial or mild aortic regurgitation was found in 3.9% of patients with the conventional modified technique and 4.0% of patients undergoing the alternative technique, during follow-up (P > 0.05). Conclusions: Compared to the conventional subcoronary implantation technique, the alternative subcoronary implantation technique reduces the incidence of new CHB and the requirement of PPI following AVR with stentless tissue valves while preserving mid-term hemodynamic function.

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Objectives: The aim of this study was to investigate the effects of 8-week endurance and resistance exercise training on release of brain natriuretic peptide. Materials and Methods: Study population was categorized into 4 groups: Group-1 (n = 6) consisted of sedentary individuals who volunteered to complete 8-weeks of endurance exercise; Group-2 (n=6) consisted of sedentary individuals who volunteered to complete 8-weaks of resistance exercise. Three blood samples [for Terminal pro BNP (NT-Pro-BNP)] were taken before, immediately after exercise and after 8 weeks of exercise training. Results: NT-Pro BNP was significantly increased immediately after endurance exercise [from 37.9 ± 1.4 pg/ml to 52.1 ±1.5 pg/ml; P = 0.002] and was decreased to 23.2 ± 9.3 pg/ml after 8 weeks of endurance exercise [P = 0.013]. On the other hand, NT-Pro BNP showed no significant changes immediately after resistance exercise [from 26.6 ± 4.9 pg/ml to 24.1 ±4.5 pg/ml; P = 0.553]. In contrast, NT-Pro BNP was significantly increased to 39.5 ±1.6 pg/ml after 8 weeks of resistance exercise [P = 0.012]. Conclusion: Endurance exercise training reduces circulating NT-Pro BNP concentration, which is likely a marker of reduced ventricular wall tension and improved myocardial function. In contrast, strength exercise induces significant increase in NT-Pro BNP, which could be partially attributed to myocardial damage.

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Background and Objectives: Obesity and overweight are major determinants of health and quality of life. The World Health Organization (WHO) has always encouraged its member states to carry out studies on the attributable burden of these diseases at the national level, and use the study as the best guide to direct the health system policy. This study was thus undertaken in order to determine the regional burden of non-communicable diseases due to obesity and overweight. Setting and Design: Counterfactual analysis of the death registration data in Markazi province of Iran was carried out. Materials and Methods : We calculated the Years of Life Lost (YLL) according to the WHO's comparative risk assessment approach. Moreover, the attributable burden of obesity and overweight was determined by multiplying the impact fraction of risk factors with the YLL of major diseases, and the counterfactual analysis method was used. Results: A total of 7,176 deaths were registered contributing to 252,214 YLL, due to premature mortality. The total YLL due to premature mortality among females and males were 102,245 and 149,969 years, respectively. The most important causes of the YLL were associated with obesity and overweight in cardiovascular diseases for females, and overweight in cardiovascular diseases for males (12,826, 8,755 and 7,375 years, respectively). Conclusion: In this study, the importance and necessity of the recognition of overweight and obesity as the major risk factors for non-communicable diseases was shown. Hence, it is necessary to develop and apply comprehensive interventions to reduce the effect of overweight and obesity, especially in females.

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An 18- year old woman with hypertrophic cardiomyopathy, aborted sudden cardiac death and implanted with an implantable cardioverter defibrillator (ICD), developed progressive fragmentation of her surface 12-lead electrocardiogram (ECG). During the follow-up, she presented with multiple appropriate ICD discharges. Here, we discuss the possible association between surface fragmented ECG and the risk of ventricular arrhythmias in patients with hypertrophic cardiomyopathy.

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Background: Monosodium glutamate (MSG), a sodium salt of glutamic acid is commonly used as flavor enhancer in Chinese, Japanese and ready to serve foods all over the World, is the inducer of oxidative stress. In the present era, MSG and alcohol is becoming a part of daily food. Concomitantly, there is a tremendous increase in the incidences of cardiovascular diseases. So, the present study was designed to elucidate the effect of MSG by evaluating the changes in oxidative stress markers in cardiac tissue of normal and alcoholic adult male mice. Materials and Methods: Animals were divided into six groups of six mice each and MSG at dose levels of 0, 4, and 8 mg/g body weight was given orally for seven consecutive days (that is from 31st day to 37 ^th day of alcohol ingestion) to chronic alcoholic (30% ethanol/100 g body weight) adult male mice. After the dose period (38 ^th day), animals were fasted overnight, sacrificed by decapitation and hearts were removed for the estimation of lipid peroxidation (LPO), xanthine oxidase (XOD), superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) and its metabolizing enzymes like glutathione peroxidase (GPx) and glutathione reductase (GR). Results: A significant (P < 0.001) increase was observed in LPO and XOD levels while a significant decrease (P < 0.001) in the levels of SOD, CAT, GSH, GPx and GR was found in cardiac tissue of normal and alcoholic animals. Conclusion: These observations suggested that oral ingestion of MSG at dose levels of 4 mg/g body weight and above with and without alcohol increased the oxidative stress and thereby, could act as an additional factor for the initiation of atherosclerosis.

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Background: Cardiac syndrome X (CSX) is a condition in which patients have the pain of angina despite normal coronary angiogram. Recently, Helicobacter pylori (H. pylori) bacteria has been associated with CSX. However, there is no obvious data about the frequency of its virulent strain (cytotoxine associated gene A: CagA) in patients with CSX. We surveyed the frequency of H. pylori and CagA antibodies in patients with cardiac syndrome X and healthy controls. Materials and Methods: Plasma samples from 100 CSX patients (61 females and 39 males; mean age: 51.8 ± 12.3 years) and 100 healthy controls (61 females and 39 males; mean age: 48.9 ± 6.3 years) were tested for the presence of IgG antibody to H. pylori using enzyme linked immunosorbent assay (ELISA) method. Also, infected patients were determined by the presence of IgG antibody to CagA by ELISA method. Statistical analysis was carried out using chi-square test and independent samples T-test. Results: Ninety two percent (92/100) of patients were anti-H. pylori positive (anti-H. pylori+), while only 56.0% (56/100) of control group were anti-H. pylori+ (P<0.01). However, prevalence of anti-CagA positive (anti- CagA+) in H. pylori infected- CSX patients and control groups were 59.8% (55/92) and 60.7% (34/56), respectively (P >0.05). Conclusion: Thus, due to the high frequency of anti-H. pylori in CSX patients, and the probable causative effect of chronic infection in vascular diseases, it is suggested that H. pylori has a probable role in the pathogenesis of CSX.

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Ischemic heart disease is accepted as the most common cause of mortality and morbidity nearly all over the world. Gout disease is the most common condition of inflammatory arthritis among the adult population. Literature includes limited information about the treatment strategies when both the conditions coexist. In this report, we present the case report of a 63 year old male patient with the diagnosis of Gout arthritis who underwent a coronary artery bypass grafting procedure successfully.

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