The future of cardiology: utilization and costs of care

Neuron specific enolase and c-reactive protein levels in stroke and its subtypes: correlation with degree of disability

Stroke is an emergency which threatens life and third leading cause of death and long term disability in developed countries. The use of biomarkers in diagnosing stroke and assessing prognosis is an emerging and rapidly evolving field. The study aimed to investigate the predictive value of biochemical marker of brain damage neuron-specific enolase (NSE) and systemic inflammatory marker C-reactive protein (CRP) with respect to degree of disability at the time of admission and short term in stroke patients. We investigated 120 patients with cerebrovascular stroke who were admitted within 72 h of onset of stroke in the Department of Neurology at Sri Aurobindo Institute of Medical Sciences, Indore, India. NSE and CRP were analyzed by solid enzyme linked immunosorbent assay using analyzer and micro plate reader from Biorad 680. In all patients, the neurological status was evaluated by a standardized neurological examination and the National Institutes of Health Stroke Scale on admission and on day 7. Serum NSE and CRP concentration were found significantly increased in acute stroke cases as compared to control in present study (<0.05 and <0.001 respectively). The maximum serum NSE and CRP levels within 72 h of admission were significantly higher in patients with greater degree of disability at the time of admission. Both biomarkers were found significantly correlated with neurological disability and short term outcome. Our study showed that serum biomarkers NSE and CRP have high predictive value for determining severity and early neurobehavioral outcome after acute stroke.

Stroke prevention: awareness of risk factors for stroke among African American residents in the Mississippi delta region

BACKGROUND

Compared to whites, African Americans have almost a 2-fold increased risk of first-ever stroke. Our study sought to determine awareness of stroke risk factors and management, symptoms, and risk reduction strategies in African Americans in Mississippi, which is part of the "stroke belt.

METHODS

We conducted a cross-sectional survey of African Americans aged 18 to 74. We collected information on awareness, sources of information, stroke risk behavior, diabetes, and hypertension prevalence: and risk reduction relating to nonsmoking, exercise, and knowledge about ideal targets of blood pressure, body mass index, total blood cholesterol, and blood sugar.

RESULTS

The percentage of respondents who identified 1, 2, 3, 4, and 5 warning signs were 21.8%, 11.7%, 15.4%, 10.1%, and 23.9%, respectively; and 17% could not identify any sign. The most factors identified were sudden numbness in the face, arm, or leg, and trouble speaking. Lifestyle factors and their role in stroke were not known to respondents. Specifically, 52.7%, 56.4%, 53.2%, 38.3%, and 28.7% failed to mention lack of physical activity, excessive alcohol consumption, diabetes, smoking, and high cholesterol, respectively, as factors that can contribute to stroke.

CONCLUSION

There is need to improve knowledge of stroke, risk reduction, and appropriate stroke response. Family, friends, and African Americans churches should be utilized to deliver stroke and other health information.

Novel patent publications on high-affinity nicotinic acid receptor agonists

BACKGROUND

Nicotinic acid (NA) has been used as a drug to treat dyslipidemia for > 50 years. In outcome clinical trials, NA displayed remarkable efficacy in patients with cardiovascular diseases by modifying lipid profiles that results in reduced morbidity and mortality. On the other hand, NA induces vasodilation (flushing) that undermines treatment compliance. In addition, high-dose treatment is required presumably owing to the poor pharmacokinetic properties of NA. The identification of the high-affinity NA receptor, namely G-protein coupled receptor 109A (GPR109A), led to further understanding of the pharmacological effects of NA and discovery of compounds that are potentially superior in efficacy yet devoid of NA's adverse effects.

OBJECTIVE/METHOD

This review focuses on the endeavors of several pharmaceutical companies to discover and develop GPR109A agonists. Representative compounds of each series in patent literature since 2005 are highlighted.

CONCLUSION

Highly potent GPR109A agonists with minimal flushing effects and robust free fatty acid reduction have been identified. Despite the failure of the partial agonist MK-0354 to achieve efficacy in a Phase II clinical trial, at least three other GPR109A agonists have been evaluated in clinical trials. The upcoming clinical data would be critical to validate the therapeutic utility of this receptor.