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Cardiovascular disease (CVD) and mental health disorders contribute to significant healthcare expenses. Lifestyle approaches that empower and enable patients to participate in their recovery are needed with the increasing complexity of cardiac patients. Traditional Tamil medical practice of Siddha self-inquiry meditation targets holistic health through intuitive lifestyle transformation. We describe 4 complex cardiac patients who explored Siddha based Hunger Gratitude Experience (HUGE) mindful eating and reported elevated levels of optimism and deeper experience of life as outlined by the 5000-year-old secular Siddha medical tradition. We cannot exclude the role of suggestion and placebo effect in descriptive series. However, the simultaneous improvement in physical health and emotional wellbeing along with demonstrated resilience against unforeseen adversities suggests this is Uvagai, the true essence of Siddha higher consciousness. Uvagai is extreme happiness and may be accessible universally with little formal training and targets positive psychology to improve wellbeing. While flow and bliss states are transient transcendental experiences, Uvagai may be more profound and therapeutic in CVD despite age and comorbidities. Seeking Uvagai can potentially overcome health disparities, including rural, minority, and underprivileged populations for better health. HUGE allows CVD patients to safely engage in Uvagai, experience higher consciousness and intuitively sustain lifestyle transformation. [ABSTRACT FROM AUTHOR]

Introduction: Over 8% of adults in the United States are estimated to have moderate (stages 3 and 4) chronic kidney disease (CKD), which is increasingly recognized as one of the independent predictors for cardiovascular (CV) disease and related mortality. Secondary hyperparathyroidism with elevated serum intact parathyroid hormone (iPTH) is associated with increased CV mortality in end-stage renal disease and this relationship is unclear in moderate CKD. Methods: Medical records of 196 patients at Harry S. Truman Memorial Veterans Hospital with stages 3 and 4 CKD (glomerular filtration rate, GFR 16-59 ml/min/1.73 m) who had iPTH levels determined from 4/2006 to 9/2007 were reviewed. CV event was defined as occurrence of any of the following during follow-up: myocardial infarction, stroke, coronary/carotid/peripheral artery revascularization, and death due to CV reasons. Results: During median follow-up of 27.2 months, 48 patients had CV events, while 148 patients did not. iPTH was elevated (156.43 ± 107.49) for patients who had CV events compared with those without (109.12 ± 86.54, P = 0.003). Among the covariates studied in the multivariate analysis including history of vascular disease, 25-OH Vit D, corrected calcium, phosphorus levels, calcium-phosphorus product, and GFR, iPTH level was found to have a positive association with CV events during follow-up period (odds ratio = 1.3 for 50 pg/ml change in iPTH, 95% CI: 1.03-1.55, P = 0.02)). Cardiovascular disease history was the only other significant variable with estimated odds ratio of 5.9 ( P = 0.002). Conclusion: iPTH level in patients with stages 3 and 4 CKD is associated with increased incidence of cardiovascular events independent of calcium-phosphorous level. [ABSTRACT FROM AUTHOR]

Diabetes is the ninth leading cause of death, directly accounting for 1.5 million deaths annually worldwide. Despite several breakthrough discoveries, little progress has been made in type 2 diabetes outcomes over the past 100 years. Younger age (below 60 years), a diet high in calories and processed food, and severe obesity (body mass index >35 kg/m 2 ) may identify reversible beta cell dysfunction. Much of the clinical presentation pertains to flooding the body's adaptive limits with overnutrition. Recognizing this as a global societal trend brought about by lifestyle changes, sedentary work, mental stress and unlimited access to calorie-dense foods is crucial. Insulin resistance and genetic abnormalities cannot account for the dramatic increase in diabetes, from only 1% five decades ago to nearly 10% today. Obesity - and not insulin resistance - is at the core of the problem. As well as hyperglycaemia, end-organ damage can also be reversed with diet and weight loss in many affected individuals. We present the evolution of our understanding and compelling reasons to reframe diabetes in the severely obese to what it really is - overweight hyperglycaemia. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles. The objective of this review is to better understand global trends and the potential to improve outcomes by reframing the diabetes narrative towards remission. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles., Competing Interests: Disclosures: Anand Chockalingam is founder of www.HiLifeJourney.org, a non-profit online self-help tool aimed at improving cardiac health and resilience through self-i nquiry, and author of Seeking HUNGER, a book encouraging self-i nquiry for holistic health. He is also an advisor at the Cardiac Wellness Institute, Chennai, India. Pandiyan Natarajanb, Smrita Dorairajanc and Uzma Khan have no financial or non-financial relationships or activities to declare in relation to this article., (© Touch Medical Media 2023.)

A 64-year-old man with angina and dyspnea due to severe two vessel coronary artery disease (CAD) was recommended for revascularization. The patient had recently learned Siddha fasting and self-inquiry meditative methods at Heartful Living, our eight-week physicianled cardiac wellness group clinic. He declined coronary artery bypass surgery and instead self-initiated a 50-day water-only fast and then switched to a vegan diet. During the fast, the patient experienced severe dehydration and electrolyte abnormalities, requiring IV fluids and electrolyte replacement. However, his hemodynamics remained stable and he had no angina, likely due to natural ketosis mediated cardioprotection. This is the first report of such a prolonged fast targeting cardiac resilience and clinical benefits in severe CAD., Competing Interests: Disclosure www.HiLifeJourney.org is a non-profit online self-help tool to improve cardiac health and Resilience through Self-Inquiry. Seeking HUNGER is a book encouraging self-inquiry for holistic health. Advisor, Cardiac Wellness Institute, Chennai, India for AC. The Office of Rural Health and Whole Health Program supports novel Siddha Self-Inquiry group clinics for Heart Failure within Truman Veterans Hospital., (Copyright 2022 by the Missouri State Medical Association.)

Bilateral hydronephrosis secondary to urinary obstruction leads to a buildup of back pressure in the urinary tract and may lead to impairment of renal function. We present a case of a 57-year-old male with a history of alcoholic liver cirrhosis, who presented with tense ascites and acute renal failure. Bilateral hydronephrosis was seen on abdominal ultrasound. Multiple large-volume paracenteses resulted in resolution of hydronephrosis and prompt improvement in renal function.