Volume 2, Issue 1

As an indispensable part of modern clinical therapeutics, nutrition support plays an important role in improving quality of life and prognosis for patients. In this paper, economic evaluation of practicing nutrition support as well as different ways and administrative patterns of nutrition support was provided to clarify how to obtain the optimal economic benefit during practicing nutrition support.

It’s no doubt that smoking causes severe impair to health, and China is the world’s number one country in terms of cigarette consumption. Based on the global situation of tobacco control and the enforcement status of the World Health Organization Frame work Convention on Tobacco Control in China, this paper proposed some measures to promote the comprehensive tobacco control, such as legislation and specification of the responsibilities of all levels of government in this respect.

Hemodynamically unstable patients under continuous renal replacement therapies (CRRT) frequently show an improvement in hemodynamic parameters and a reduction in vasopressor agents. Different mechanisms have been proposed to explain this effect. A high rate of fluid exchange between interstitial and intravascular compartments seems to contribute to the therapeutic effect of CRRT. Other mechanism that seems to play a role is cooling; a raise in BP and SVR will follow a moderate heat loss but this effect will be accompanied by a decrement in oxygen delivery that can be detrimental and, when the cooling is severe, a shock can theoretically be precipitated. Metabolic acidosis, usually present when RRT is started, is a proinflammatory stimulus and conditions vasopressor unresponsiveness; the efficient control provided by CRRT can explain in part a positive hemodynamic response. Ionized calcium may have a role based on a potential effect on cardiac function and has been used in some studies in high concentration but there are limited in vivo data supporting this effect. The role of sodium concentration as a factor influencing hemodynamic tolerance has been reported for IHD but for CRRT has not been studied so far. Clearance of cytokines is the central key factor proposed as a mechanism for hemodynamic improvement but we have conflicting data regarding elimination. The volume of fluid exchange involved is a critical factor in order to reach an effective clearance but at this point we lack a proven theory for the way CCRT works. In this review we aim to explore possible mechanisms involved in the hemodynamic effect of CRRT on critically ill unstable patients.

Nicotine replacement therapy (NRT) is the use of various forms of nicotine delivery methods intended to replace the nicotine obtained from smoking or other tobacco usage. This reduces the withdrawal symptoms associated with smoking cessation and helps resist the urge to smoke cigarettes. The aim of this review is to determine the effectiveness of the different forms of NRT (chewing gum, transdermal patches, nasal spray, inhalers, and tablets) in achieving asceticism from cigarettes. As a method of delivering nicotine into the bloodstream, NRT is thought to be a comparatively less-dangerous method than tobacco smoking.

Bone marrow microvessel plays an important role in the onset and progression of hematologic diseases whose genesis is regulated by a variety of regulatory factors. Since abnormal angiogenesis has been found in a number of malignant and non-malignant hematologic diseases, microvessel density can be a valuable prognostic indicator, and also a stratifying factor in some of these diseases. In some cases, inhibiting or stimulating angiogenesis with certain treatments may be very important in improving therapeutic outcomes. However, mechanisms underlying these effects are yet to be further investigated.

With the transformation of the medical model to a bio - psycho - social medical model, people are becoming more and more concerned about psychological and social factors in the development, prognosis and treatments of cardiovascular diseases. Some prospective studies have shown that depression/anxiety may be one of the risk factors for coronary diseases; it can accelerate the progression of the disease and may also be a risk factor for poor prognosis. However, depression/anxiety-complicated coronary diseases is rarely recognized by nonpsychiatrists; therefore, these patients often fail to receive timely diagnosis and treatment and may even undergo further psychological and economic burden because of excessive examination and treatment. Identification and intervention of coronary diseases associated with depression/anxiety as early as possible is yet to be achieved. This article reviews how to identify coronary diseases patients with depression/anxiety and how the common depression/ anxiety scales are used and evaluated nowadays.

Background:Malnutrition has been shown to have an adverse effect on the clinical outcome of surgical patients. A >10% body weight loss in the previous 6 months is a significant preoperative predictor of worse post-operative outcome. There are limited data on malnutrition in vascular surgery patients. The current study was designed to investigate the prevalence of malnutrition in elective vascular surgery patients. Materials and Methods: This is a prospective, observational, auditing study carried out in department of vascular surgery of a tertiary, university and teaching hospital. All patients scheduled to undergo vascular surgery in a 4-month period were screened for malnutrition using the Nutritional Risk Score 2002. Nutritional status was assessed by body weight, body mass index, serum albumin and physical examination by a member of the hospitals’ nutrition team. The body weight was determined daily until 30 days post-operatively. Statistical analysis was performed using SPSS Statistics, Release Version 20.0.0. Results: On admission, 14 of 23 patients (61%) were at risk of malnutrition (Nutritional Risk Score 2002 ≥ 3). Assessment revealed no false-positive results. The mean post-operative body weight declined until Day 9. Afterwards, it rose with a mean weight gain of 1.32 kg. Conclusions: Malnutrition remains a largely unrecognized problem in vascular surgery patients. Given its detrimental effect, screening for malnutrition should be implemented in the pre-operative workup and therapeutic flow charts should be made available. Clear guidelines should also been made available for the bedside clinician.

Objective: Diabetes mellitus confers an increased cardiometabolic risk in affected individuals. Several mechanisms underlie this equation, but endothelial dysfunction has been implicated as the final common pathway by several studies. Endogenous nitric oxide (NO) is one of the principal molecules mediating normal endothelial vasodilation. This study was aimed at ascertaining the effects of smoke and non-smoke tobacco, both of which are commonly used by Indians, on the serum NO levels. Materials and Methods: A total of 208 type 2 diabetic patients attending the diabetes clinic were enrolled in this study. Data on age, gender, smoking, and tobacco chewing were collected, and the serum levels of NO determined using nitrate reductase and Griess Reagent which converts nitrite to a deep purple azo compound. The amount of the azochromophore accurately reflected the amount of NO in the samples. Results: The mean value of serum NO in smokers was 54.92 μmol/L, as compared to 60.60 μmol/L in non-smokers. The mean value of serum NO in tobacco chewers was 57.32 μmol/L and in tobacco non-chewers was 60.61 μmol/L. In this study, a near-significant association was found between the low serum levels of NO in smokers as compared to nonsmokers. But there was no significant association of serum NO levels in tobacco chewers and non-tobacco chewers. Conclusion: In this study, the difference in effects of different forms of nicotine usage on the NO levels was assessed, as it provides an insight into the mechanism of the effects of oral versus inhaled forms of nicotine use. In conclusion, new facts have been elucidated in this study, and to the best of our knowledge, this is the first comparison of smoke and nonsmoke tobacco in relation to the serum levels of NO for estimating the burden of vascular risk with various forms of tobacco use in diabetes.

Hemoptysis is the predominant symptom of tuberculosis and is considered as important clue toward evaluation of tuberculosis and treatment accordingly, especially in high burden countries like India where disease is endemic. 8-25% cases of pulmonary tuberculosis are having hemoptysis during course of their illness. Unexplained hemoptysis with normal chest radiograph needs further evaluation including CT thorax and bronchoscopy. Bronchoscopy would be ideal choice for confirming diagnosis and to localize exact site of bleeding as well. In this case report, we describe a case of a young male who presented with cough and intermittant hemoptysis. During fiberoptic video-bronchoscopy we noted exophytic endobronchial growth in right main stem bronchus. Histopathological evaluation suggests mucoepidermoid carcinoma (MEC) of salivary gland type originating from main stem bronchus right side. PAS and mucicarmine staining differentiated MEC from Adenocarcinoma in our case.

Spontaneous carotid cavernous fistula is usually caused by lesions in the internal carotid cavernous sinus and its branches. We report a young male patient with no history of trauma, in whom the fistula was located at the cavernous sinus of the internal carotid artery. The postoperative angiography found a pseudoaneurysm at the origin of the cavernous sinus of internal carotid artery, which suggested that cavernous sinus fistulas were caused by bleeding from rupture of thin-walled vessels due to the local abnormalities of the vascular wall.