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1.
Article | IMSEAR | ID: sea-216227

ABSTRACT

Background: The diagnosis of heart failure (HF) remains essentially clinical-Based. However, the history, physical examination, and chest radiograph findings are often inadequate in the diagnosis because multiple other conditions that affect the cardiopulmonary system mimic the symptoms of HF. N-terminal pro-BNP (NT-proBNP) has long been used for diagnosing HF. N-terminal pro-BNP values vary with different patient parameters. There is a scarcity of Indian studies on this topic. Especially with the use of newer drugs like angiotensin receptor neprilysin inhibitor (ARNI), it is important to have data from our own population on the same. Aims and objectives: (i) To assess the role of NT-proBNP in the diagnosis of HF. (ii) Achieve diagnostic clarity in cases having cardiorespiratory symptoms and signs like acute onset dyspnea, pedal edema, and basal crepitations. (iii) To study the effect of various factors like age, body mass index (BMI), and creatinine on NT-proBNP. (iv) Establish a relation between NT-proBNP levels and left ventricular ejection fraction (LVEF), disease severity, and etiology of HF. Materials and methods: An observational prospective study of 50 patients presenting with acute onset breathlessness was carried out, fulfilling inclusion and exclusion criteria over a period of 10 months. Detailed history and examination of the patients were obtained. Venous sample for the measurement of NT-proBNP was collected within 24 hours of onset of symptoms. Other relevant blood and radiographic investigations were obtained. The NT-proBNP “cut-offs” set forth by the American Heart Association (AHA)/American College of Cardiology (ACC) were used to “rule in” or “rule out” HF. Two-dimensional echocardiography (2D Echo) was used to confirm the diagnosis. The correlation between NT-proBNP and various parameters like age, BMI, creatinine, and LVEF was obtained. Sensitivity and specificity tests were applied as well. Results: Out of the 50 patients presenting with acute onset dyspnea, the most common cause was ischemic heart disease (IHD) (44%) followed by dilated cardiomyopathy (DCM) (32%), chronic obstructive pulmonary disease (COPD) (10%), anemia (4%), followed by other causes. The median NT-proBNP value was the highest for IHD patients (9485 pg/mL), followed by DCM (8969 pg/mL), followed by COPD (2846 pg/mL), and followed by anemia (850 pg/mL). There is a significant positive correlation between NT-proBNP and age (coefficient of correlation r = 0.4007, significance level p = 0.0389, and class interval = 0.137–0.61). There is a significant negative correlation between creatinine clearance and NT-proBNP (coefficient of correlation r = –0.372, significance level p = 0.007, and class interval = –0.58 to –0.105). There was significant negative correlation between LVEF and NT-proBNP (coefficient of correlation r = –0.36, significance level p = 0.009, and class interval = –0.58 to –0.09). Higher LVEF is associated with lower NT-proBNP values. There is marked heterogeneity in the values though. Conclusion: It is seen that the values of NT-proBNP vary with factors like age, BMI, and creatinine clearance in addition to LVEF. This may lead to falsely positive or falsely negative diagnosis of HF. With the above observations in mind, it can be concluded that NT-proBNP can help diagnose HF but only in addition to clinical findings.

2.
Article | IMSEAR | ID: sea-202659

ABSTRACT

Introduction: Diabetes Mellitus is associated with manycomplications such as microvascular, macrovascular andnon vascular. Presence of anemia in diabetes is due to thedisease itself rather than usual causes of anemia. Apart fromcausing usual symptoms, anemia also increases the risk ofcardiovascular disease in diabetics. Here, we have conducteda study to compare the presence of anemia in patients withDiabetes, with that in healthy population.Material and Methods: A case-control study was conductedin a tertiary care hospital setting in Vadodara,Gujarat. A totalof 120 patients were enrolled, of which 60 were cases whohad Diabetes Mellitus type 2 and 60 were healthy controls,matched for age and gender. A detailed clinical history andexamination was done for both cases and controls. Bloodinvestigations in form of a complete hemogram, thin peripheralsmear, blood sugar and serum creatinine was done. Onlyindividuals with normal serum creatinine levels were includedin the study. Comparison was done between the two groupsfor the presence of anemia, in absence of renal involvement.Results: Anemia was more prevelant in patients with Type 2Diabetes Mellitus when compared to controls (Odds Ratio =2.04, P < 0.05). On comparing the anemic cases and controlsin both genders, the Odds ratio for males and females was 2.14and 2.04 respectively with P < 0.05.Conclusion: Patients with diabetes mellitus type 2 are at ahigher risk of suffering from anemia irrespective of their renalfunction.

3.
Article | IMSEAR | ID: sea-202537

ABSTRACT

Introduction: Chronic acquired hepatocerebral degenerationis a rare disorder typically accompanied by cognitivedisturbances and parkinsonian features secondary to liverdisease. It is the deposition of manganese in the basal ganglialeading to T1 hyperintensity on MRI of these patients and theresulting clinical features. Familial association is found insome cases.Case report: Here, we report the case of a 32 year old postpartum female who presented with tremors and historyof liver disease. MRI of the brain showed symmetrichyperintensities in globus pallidi, substantiae nigrae, andsuperior cerebral peduncles in T1-weighted images. Althoughliver transplantation is the best modality of treatment atpresent, the patient showed improved on treatment withLevodopa+carbidopa.Conclusion: It is important to recognize this disease entity forsymptomatic relief of the patient. However further research isrequired for better management.

4.
Article in English | IMSEAR | ID: sea-182510

ABSTRACT

Aims: To evaluate the cardiac status in patients with sickle cell anemia and sickle cell trait by 2D echocardiography (2D Echo) with specific reference to pulmonary hypertension (PH) and to assess prevalence and severity of PH in this population. Study design: A prospective, cross-sectional study was done in 50 patients with sickle cell disease in whom. 2D Echo was performed, which assessed their cardiac status with specific reference to PH. Material and methods: The study was conducted on outdoor and indoor patients of the Dept. of Medicine at Shri Sayajirao General (SSG) Hospital, Vadodara, Gujarat. The study was conducted over a period of 18 months in 50 patients with sickle cell anemia as well as sickle cell trait. Results: The present study revealed that PH was present in one-third of patients with sickle cell disease. Conclusion: Pulmonary arterial hypertension is one of the leading causes of morbidity and increased mortality in adults with sickle cell disease.

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