Christiaan Barnard
South Africa 1922 - 2001, Paphos, Cyprus
 
Seven years after Barnard performed the world's first highly publicized heart transplant (1), he made medical history once again when he performed a "twin-heart" operation on November 25, 1974.  In the procedure, Barnard removed only the diseased portion of the patient's heart — one-third of the left ventricle. Barnard then joined the left atrium to the atrium of a second donor heart. The operation was considered less radical than total heart replacement and was conducted without a heart-lung machine. With both hearts beating, the second acted as a booster for the first. The patient died four months later, however, of unrelated causes. (2, 3)
 
Rheumatoid arthritis had plagued Barnard prior to 1956, when it was diagnosed during his postgraduate work in the United States (4), this limited his surgical experimentation in later years.As a result, he turned to writing novels, books on health/medicine/South Africa while serving as a scientific consultant.

Electrocardiogram (EKG) and Echocardiogram

An electrocardiogram (EKG or ECG) and an echocardiogram (echo) are tests that help find problems with the heart muscle, valves, or rhythm. You may need 1 or both of these tests before starting some chemotherapy drugs. 

Chemotherapy drugs for rheumatoid arthritis

There are many chemotherapy drugs for treating cancer but few drugs are only used to treat rheumatoid arthritis, and they are Rheumatrex (methotrexate), Azathioprine (imuran), and Cytoxan (cyclophosphamide).

  • Rheumatrex or methotrexate, formerly known as amethopterin. It is an antimetabolite and antifolate drug used formerly in treating cancer but now used to treat some auto immune disease like rheumatoid arthritis by replacing more toxic antifolate aminopterin. Polymyositis and inflammation of blood vessels or vasculitis are effectively treated by this drug. The dosage can be taken orally regularly or orally but can be injected weekly. There are some mild and severe side effects using these drugs like body discomfort, headache, hair loss, appetite loss, nausea, stomach pain, rash, swelling of mouth, lips, chest pain, etc.
  • Azathioprine or imuran is a purine analogue immunosuppressive drug, and is generally used to treat autoimmune disease like rheumatoid arthritis. It is generally used to decrease vacuities, lupus, etc. Trere are also several side effects using these drugs like developing certain types of cancer, lymphoma, anemia, weight loss, night sweat, itching, fever, and some skin rashes. This drug is also helpful as it prevent the rejection of kidney transplant and certain type of bowel condition.
  • Cytoxan or cyclophosphamide is a nitrogen mustard alkylating agent and is used to treat various types of cancer and auto immune disease. It is generally combined with other chemotherapy drugs to treat lymphomas and rheumatoid arthritis and is quite more powerful and toxic than those of Rheumatrex and Azathioprine. It is used to treat rheumatoid arthritis, if it becomes more aggressive, such as severe lupus, and vasculitis. It works by affecting the rapid growing cells present in the immune system, but can affect those cells also which does not multiply, if the dosage is more.
  • Benefit-Risk Assessment of Leflunomide.  Adverse events reported include gastrointestinal upset, hypertension, headache, hepatotoxicity and hair loss, as well as predisposition to infection and peripheral neuropathy.  Leflunomide is considered a cytostatic rather than cytotoxic agent. Two mechanisms of action have been proposed: the reversible inhibition of dihydrooroatase dehydrogenase (DHODH), a key enzyme in pyrimidine synthesis, as well as the inhibition of tyrosine kinases.[

Central Nervous System Vasculitis (CNS Vasculitis)

Central Nervous System (CNS) vasculitis is an inflammatory brain disease targeting the blood vessels of the brain and/or spinal cord. In this disease, cells of the immune system attack the brain blood vessel walls, which leads to swelling and damage of the wall itself and the surrounding brain tissue.

Sometimes, part of the artery wall becomes inflamed, which can lead to swelling of the wall. This expansion or swelling of the artery wall can secondarily narrow the lumen of the artery, through which blood flows into the brain. If the narrowing is severe enough, there may not be enough blood flow to the brain and the patient may start to experience symptoms of stroke. Finally, the artery can close altogether.

There are many different kinds of vasculidites (inflammations of vessels). Most cases of CNS vasculitis occur as a part of autoimmune or inflammatory disorders, such as:

  • rheumatoid arthritis
  • systemic lupus erythematosus
  • dermatomyositis, Wegner’s Granulomatosis, and Behçet’s disease
  • as part of bacterial/vrial infection, and affect even smaller vessels
  • primary angiitis of the CNS (PACNS), a condition of isolated CNS vascular inflammation in absence of systemic disease

Symptoms include:

  • severe headache, long-lasting
  • strokes (transient ischemic attacks)
  • forgetfulness/confusion
  • weakness
  • vision problems
  • seizures
  • encephalopathy
  • sensation abnormalities

Top Ten Most Abundant Proteins In Human Plasma

1.  Albumin

  • normal albumin range is 3.4 to 5.4 g/dL.
  • balance of albumin to keep fluid from leaking out of blood vessels. Albumin gives your body the proteins it needs to keep growing and repairing tissue. It also carries vital nutrients and hormones. 
  • lower level = may suggest a problem with the liver or kidneys, may also indicate that a person has a nutrient deficiency, or an inflammatory disease
  • Higher than normal levels of albumin may indicate dehydration or severe diarrhea. If your albumin levels are not in the normal range, it doesn't necessarily mean you have a medical condition needing treatment. Certain drugs, including steroids, insulin, and hormones, can raise albumin levels.
  • foods high in albumin = beef, milk, cottage cheese, eggs, fish,Greek yogurt.

2.  Ig gamma-1 chain C region (2)

 

3.  Ig kappa chain C region (3)

 

4.  Apolipoprotein A-I (4)

  • reference range of Apo-A1 varies by sex, as follows: Men: Greater than 120 mg/dL (1.2 g/L) Women: Greater than 140 mg/dL (1.4 g/L)
  • helps to clear fats, including cholesterol, from white blood cells within artery walls

5.  1g lambda-2-chain C regions (5)

 

6.  1g gamma-2-chain C region (6)

 

7. Serotransferrin (7)

  • The levels of serotransferrin were significantly decreased in RA patients

8.  alpha 1 antitrypsin (8)

  • A lack of Alpha1-antitrypsin in patients with rheumatoid arthritis could allow inflammation to increase because of uninhibited lysosomal enzymes

9. Apolipoprotein  A-II  (9)

  • RA patients had significantly lower levels of apolipoprotein (apo)A-I and lipoprotein (Lp)A-I:A-II

10.  Alpha 2 macroglobulin (10)

  • RA synovial fluid also contains a twofold higher median alpha(2)M level than OA

 

For the past two decades, heart disease kills more people than any other medical condition worldwide. (1)(2)  Nearly all research has gone into establish some sort of behavioral or environmental link (smoking, diet, exercise, stress, and so on), with a smaller fraction of known genetic causes.  Except in rare cases of acute infection, such as infectious endocarditis, microbes have been thought of as irrelevant until 2013.

Trimethylamine-N-oxide, or TMAO isn't a microorganism itself; rather, it's a product created by bacteria when they digest lecithin, not to be confused with lectin. A lectin is a type of carbohydrate-binding protein that sticks to the cell membranes in the digestive tract, while lecithin is a group of fatty substances found in plant and animal tissues.

In a study published in The New England Journal of Medicine, a team led by Cleveland Clinic's Stanley Hazen found that human subjects with the highest levels of TMAO in their blood had about twice the risk of having a heart attack, stroke, or death compared with those who had the lowest TMAO levels.(1)  Measuring and targeting TMAO levels is something doctors can do with a simple blood test.

 

Vascular Anatomy of the Dorsal Hand