An equation to explain variations in blood NT-proBNP in ambulatory cardiac subjects.

BACKGROUND: NT-proBNP is being used as a biomarker for prognosticating and delineating cardiac dysfunction. The cut-off value for deciding normal versus abnormal levels has always been a point of contention since it depends on the degree of dysfunction as well as other associated conditions often termed non-cardiac factors and parameters. Such association had not been formally presented. OBJECTIVE: To determine the direction and magnitude of effect of cardiac and non-cardiac parameters on NT-proBNP variability. MATERIAL AND METHOD: The present study included 78 cardiac ambulatory patients with a history of heart failure and/or low left ventricular ejection fraction. Their cardiac and non-cardiac parameters were recorded at the time of blood sampling for NT-proBNP. Multivariate linear regression analysis was used to correlate cardiac and non-cardiac parameters with NT-proBNP level and, from this, a predictive equation was derived. RESULTS: Log [NT-proBNP (pmol/l)] was 1.424 + 0.348 (for EF of 18-27) + 0.636 (for EF < 18) + 0.021 CTR - 0.002 SMW- 0.326 for female + 0.430 Cr - 0.010 BW [EF = LV ejectionfraction in %; CTR = cardio-thoracic ratio in %; SMW = 6-minute walking distance in meters; Cr = serum creatinine in mg/dl; BW = body weight in kg]. The adjusted R-square for this regression was 0.659. Omitting the non-cardiac variables (sex, Cr, BW) would decrease the adjusted R-square to 0.493. CONCLUSION: Cut-off value for NT-proBNP concentration in subjects without severe systolic heart failure has to account for these non-cardiac factors.

Associations between floor activities and knee osteoarthritis in Thai Buddhist monks: the Songkhla study.

OBJECTIVE: Whether floor activity, a common daily activity among Buddhist monks, is a risk factor for knee osteoarthritis remains controversial. The objective of the present study was to search for any association between floor activities and knee osteoarthritis. MATERIAL AND METHOD: This population-based survey involved 261 monks, 40 years of age or older from Songkhla province in the southern part of Thailand Histories were taken on lifetime floor activities in four common positions, squatting, lotus, side-knee bending, and kneeling. Radiographic investigations included antero-posterior and skyline views of both knees. Diagnosis of osteoarthritis in each compartment was based on Kellgren & Lawrence grade 2 or more. Logistic regression analysis adjusted for age, body mass index and smoking status was used to identify the associations between lifetime floor activity and knee osteoarthritis. RESULTS: The mean age (SD) of monks in the present study was 60.4 (12.7) with mean age at ordination 44.4 (17.6) years. The lotus and side-knee bending positions were the two most common practices. Using the lowest tertile of exposure to lotus position as a reference, the third tertile had an odds ratio of 1.0 (95% CI; 0.5-2.2) associated with radiographic knee osteoarthritis. The corresponding odds ratio for side-knee bending was 0.8 (95% CI; 0.3-1.7), for squatting 2.1 (95% CI; 0.9-4.5), and for kneeling 0.7 (95% CI; 0.3-1.5). There was no significant association between the average daily lifetime floor activity in any positions and symptomatic radiographic knee osteoarthritis. CONCLUSION: Floor activities involving squatting, lotus, side-knee bending and kneeling do not increase the risk of knee osteoarthritis in Thai Buddhist monks.

Comparison of validity, and responsiveness between general and disease-specific quality of life instruments (Thai version) in knee osteoarthritis.

Short-form 36 (SF-36) and Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) are common instruments for measuring quality of life (QoL) in patients with knee osteoarthritis. The goal of the present study was to compare the performance of both instruments in evaluating QoL in patients with knee osteoarthritis as diagnosed by the American College of Rheumatology (ACR) criteria. Treatment included nonsteroidal anti-inflammatory drugs and patient education for 6 weeks. Face-to-face interview by an orthopaedist was done at baseline and after treatment, including collection of demographic data and use of both SF-36 and WOMAC questionnaires. Evaluation of instrument performance included reliability, validity, and responsiveness measures. Reliability was tested by analysis of internal consistency using Cronbach's alpha at baseline and after treatment. Construct validity was computed by determining the correlation between each domain of SF-36 and WOMAC (Pearson's test). Responsiveness was compared between baseline and after treatment of both SF-36 and WOMAC in each domain using the paired t test. Fifty-two patients (8 men, 48 women) with a mean age of 58.4 years were included in the present study. About 75% of subjects had less than secondary education levels and most were from agricultural communities. Sixty-four percent had mild grade knee osteoarthritis. The internal consistency of WOMAC revealed good levels of reliability, both at baseline and after treatment, in all dimensions. The reliability of SF-36 was relatively low, especially in the role physical and bodily pain dimensions (Cronbach's alpha < 0.700). Construct validity between each dimension in SF-36 and WOMAC demonstrated coefficients ranging from -0.05 to -0.409. Both WOMAC and SF-36 showed good responsiveness when comparing scores before and after treatment in all domains. In conclusion, both the Thai version WOMAC and SF-36 were valid, reliable, and sensitive to change in evaluating QoL in Thai patients with knee osteoarthritis.

Neonatal mortality in rural Bangladesh: an exploratory study.

Bangladesh has a neonatal death rate that is substantially high and demands urgent attention. To assess the causes of neonatal mortality, 1,019 pregnant women were followed up in eight randomly-selected rural areas of the country. Trained female interviewers visited the households of the subjects at four-week intervals to record neonatal deaths (within 28 days after birth). For each death, they administered a structured verbal autopsy questionnaire to the mother and/or a close family member. Based on these field data, three neonatologists arrived at a consensus to assign two causes of death--an originating cause and a direct cause. The neonatal mortality rate was 53.5 per 1,000 livebirths. The originating causes of death were pre-maturity/low birth-weight (30%), difficult labour (16%), unhygienic birth practices (16%), others (4%), and unknown (34%). The direct causes were sepsis (32%), asphyxia (26%), tetanus (15%), respiratory distress (6%), others (6%), and unknown (14%). According to the prevailing causes of neonatal deaths, implementation of intervention programmes, often in the community, that do not depend on highly-technical training or sophisticated equipment should be implemented.