Ketone body therapy: from the ketogenic diet to the oral administration of ketone ester.

Ketone bodies (KBs), acetoacetate and β-hydroxybutyrate (βHB), were considered harmful metabolic by-products when discovered in the mid-19th century in the urine of patients with diabetic ketoacidosis. It took physicians many years to realize that KBs are normal metabolites synthesized by the liver and exported into the systemic circulation to serve as an energy source for most extrahepatic tissues. Studies have shown that the brain (which normally uses glucose for energy) can readily utilize KBs as an alternative fuel.

Very low-activity stress/high-activity rest, single-day myocardial perfusion SPECT with a conventional sodium iodide camera and wide beam reconstruction processing.

Background: A stress (S)/rest (R) 1-day Tc-99m sestamibi protocol is logistically advantageous and facilitates stress-only imaging. However, with conventional 370 MBq (10 mCi) S activity and subsequent 1,110-1,295 MBq (30-35 mCi) R activity there is a risk of S-to-R "shine-through" and underestimation of defect reversibility. New software methods cope with lower counting statistics and should allow for both a reduced S activity and also less likelihood of S-to-R "shine-through.

A comparison of the image quality of full-time myocardial perfusion SPECT vs wide beam reconstruction half-time and half-dose SPECT.

Objectives: Wide Beam Reconstruction (WBR) (UltraSPECT, Ltd) uses resolution recovery and noise modeling to cope with decreased SPECT count statistics. Because WBR processing reconstructs half the usual SPECT count statistics, we postulate that image quality equivalent to a full-time acquisition can be achieved in either half the time or with half the radiopharmaceutical activity.

Methods: In 156 consecutive patients (pts) rest and 8-frame gated post-stress myocardial perfusion SPECT was performed following 333-444 and 1184-1480 MBq (9-12 and 32-40 mCi) Tc-99m sestamibi injections, respectively, with full-time (rest = 14 min; stress = 12.

Long-acting calcium antagonists in patients with coronary artery disease: a meta-analysis.

Background: The use of calcium channel blockers (CCBs) in patients with coronary artery disease remains controversial, with reports of increased risk of myocardial infarction and all-cause mortality. Short-acting CCBs have an unfavorable hemodynamic profile. The role of long-acting CCBs in patients with coronary artery disease is unknown.

Beta-blockers for primary prevention of heart failure in patients with hypertension insights from a meta-analysis.

Objectives: This study sought to evaluate the efficacy of beta-blockers (BBs) for primary prevention of heart failure (HF) in patients with hypertension.

Background: The American College of Cardiology/American Heart Association staging for HF classifies patients with hypertension as stage A HF, for which BBs are a treatment option. However, the evidence to support this is unknown.

Clinical considerations on the use of concomitant therapy in the treatment of acne.

Acne is a disease that affects millions of people worldwide and requires prompt and effective management of both the physical and psychological sequelae that an individual may experience. The ultimate goal of treatment is to address as many of the pathogenic factors of acne as possible while minimizing side effects. Numerous therapeutic options are available; however, most current treatment options address only one or two of these factors.

Side effects as influencers of treatment outcome.

Research relative to the efficacy of a therapeutic agent commands a clinician's greatest interest, but treatment decisions are made based on optimizing efficacy and tolerability/safety considerations. Second-generation atypical antipsychotic drugs are a study in the importance of taking a careful look at the full benefit-risk profile of each drug. The disorders that atypical antipsychotics are approved to treat--schizophrenia, schizoaffective disorder, and bipolar disorder--are associated with an increased rate of certain medical comorbidities compared to the general population.

A meta-analysis of 94,492 patients with hypertension treated with beta blockers to determine the risk of new-onset diabetes mellitus.

Beta blockers used for the treatment of hypertension may be associated with increased risk for new-onset diabetes mellitus (DM). A search of Medline, PubMed, and EMBASE was conducted for randomized controlled trials of patients taking beta blockers as first-line therapy for hypertension with data on new-onset DM and follow-up for > or =1 year. Twelve studies evaluating 94,492 patients fulfilled the inclusion criteria.

Identification and management of patients with hypertension in the polyclinic system of the Russian Federation.

Background: Cardiovascular diseases, including hypertension and type 2 diabetes mellitus, are the major determinants of poor health in the Russian Federation.

Methods: This study assessed the feasibility of establishing a program to identify and manage hypertension and associated cardiovascular risk factors in an outpatient clinic within the Russian polyclinic system. In urban polyclinic in Kazan, Tatarstan, which is responsible for 77,000 covered lives, we enrolled 192 patients with hypertension of whom 68 had type 2 diabetes mellitus screened from various clinics within the polyclinic.

Echocardiographic validation of gated SPECT ventricular function measurements.

Unlabelled: Left ventricular (LV) volumes are valuable prognostic indicators in the management of coronary artery disease and traditionally have been obtained by x-ray contrast angiography or echocardiography. There now are several scintigraphic methods to compute volumes that are based on different LV modeling assumptions. Both the reasons that calculations from different nuclear techniques can disagree with one another and the relationship of these values to the more conventional echocardiographic measurements must be investigated thoroughly for calculations to be interpretable for individual patients.

Image enhancement of severely hypoperfused myocardia for computation of tomographic ejection fraction.

Unlabelled: Ejection fractions computed from 99mTc-sestamibi myocardial perfusion gated tomograms have demonstrated a high degree of accuracy and reproducibility. Although automated algorithms appear to provide reasonable endocardial outlines for patients over a broad spectrum of cardiac diseases, in cases of severe hypoperfusion, it is necessary to manually adjust contrast and brightness to judge whether borders are correct or must be altered.

Methods: Midventricular horizontal and vertical long axis gated tomograms were generated for 116 studies chosen on the basis of extensive, severe myocardial perfusion defects.