ABSTRACT
Introduction: Heart failure is the leading contributor to global morbidity and mortality. Frailty is an emerging prognostic factor in heart failure. There is little data on the prognostic role of frailty in patients admitted for acute heart failure as most studies have been done on stable heart failure patients. Methodology: The study included elderly (age ≥60 years) patients admitted with acute heart failure at a tertiary care center in India. Patients with dementia, cognitive impairment, and documented terminal illness were excluded. The sample size was 85 patients. Frailty assessment was done using short performance physical battery (SPPB) and Fried phenotype scales and follow‑up data was collected at 3 months postdischarge telephonically. The primary objective of the study was to determine the proportion of frailty in elderly in‑hospital heart failure patients. The secondary objectives were to see the agreement between the frailty assessment tools used (SPPB and Fried phenotype). Results: Eighty seven patients were included in the study. The majority were male (n = 45) and had heart failure with reduced ejection fraction (n = 56). Coronary artery disease (CAD) (n = 60) was the most common cause of heart failure. Eighty-two patients had at least one comorbidity. The proportion of frailty as per the SPPB was 43.67%, and as per the Fried phenotype was 68.9%. A total of 4 deaths and 15 re-admissions occurred during the follow-up period of 3 months. The majority belonged to the frail category as per both the frailty scales (P < 0.001 for SPPB, P = 0.087 for Fried phenotype). Fleiss’s kappa coefficient for agreement between the scales was 0.373 (SE = 0.106, P < 0.001), which signifies that there was a fair agreement between the two scales. The Spearman Rank correlation coefficient was −0.691 (P < 0.01) between the two scales. Hence, the SPPB score inversely correlated with the Fried phenotype. Conclusion: Frailty is largely prevalent in elderly heart failure patients. It can be used to predict poor outcomes in these patients. Clinicians should identify these high-risk patients at the time of discharge from their facility and consider interventions (tailored rehabilitation programs) to minimize the adverse outcomes.
ABSTRACT
Introduction: Dental aesthetic plays an important role inoverall facial representation of a person. A smile enhancesexpression of a person. A perfect harmony of size, form, andposition of the teeth and their relation with alveolar boneand gingival tissue have important role in creating a pleasingsmile. Excessive gingival melanin pigmentation can givebrownish to blackish colour to gingival.Case report: This case report highlights a case ofhyperpigmentation gingiva with midline diastema which wastreated by gingival depigmentation using the scalpel techniquewith frenectomy and cosmetic filling.Conclusion: The appearance of ‘black gum’ especially inhigh smile line person gives unaesthetic smile. The demandfor cosmetic therapy is commonly in people with pigmentedgingiva.