ABSTRACT
Introduction@#Obesity remains to be a public health concern across the globe. Studies have established that obesity plays an important role in the pathogenesis and progression of cardiovascular diseases such as hypertension and coronary artery disease. Evidence suggesting the link between obesity and decompensation of heart failure is only just emerging.@*General Objective@#Determine the associations between body mass index (BMI) outcomes of severity and mortality among adult Filipino patients admitted with decompensated heart failure.@*Study Design@#Retrospective Cohort study design.@*Study Setting@#Chong Hua Hospital, a tertiary hospital in Cebu City, Philippines@*Study Population@#All adult patients with a diagnosis of Decompensated heart failure who were admitted in the hospital from 2015 to 2019. @*Main Outcome Measure@#Determine association of BMI using Asian cut-offs and Outcomes of patients admitted for decompensated heart failure.@*Results@#A total of 356 patients were admitted for acute decompensated heart failure from year 2015-2019. Majority of the patients were in the obese category 1 (28.93%) and predominantly were classified as NYHA Class III heart failure. There was no significant association between BMI and outcomes among patients with decompensated heart failure. Furthermore, it was noted that the pro-BNP values were higher in patients with lower BMI categories than in the overweight and obese categories.@*Conclusion@#Obesity, while increasing the chance of developing heart failure (HF), appears to protect people who have already been diagnosed with HF (the "obesity paradox"). This study, although not reaching statistical significance, showed that patients with lower BMI admitted for heart failure decompensation had increased use of positive pressure ventilation and higher mortality rates compared to obese patients. A larger sample size may be needed to show such association. Furthermore, patients in lower BMI category had higher pro-BNP values than their counterparts consistent with previous literature.
ABSTRACT
Background@#Pyoderma gangrenosum is a rare ulcerative skin disease that can present as an ulcerative skin disease with the prominence of pain. The pathogenesis may be related to disruptions in the immune pathways. Targeted therapy is lacking and current treatment is largely empirical and consists of corticosteroids and cyclosporine first line. Early recognition can improve clinical outcomes.@*Case@#This case is a 67-year-old male diabetic who was admitted for a progressive ulcerative lesion on the right leg. Arterial Doppler studies and CT angiogram of the right lower extremity were normal. Blood and deep wound cultures of the lesion showed Klebsiella pneumoniae and Pseudomonas aeruginosa. Multiple antibiotic regimens were given with no improvement of the ulcerating lesions of the leg. Pain on the lesion remained persistent. The tissue biopsy of the lesion taken during debridement revealed that it was a pyoderma gangrenosum with dystrophic sclerosis. Oral prednisone at 1 mg/kg was added to the regimen which improved pain but the lesion did not improve. The persistence of the pain and progression to sepsis during the hospital course prompted the decision to do an above-knee amputation of the right leg. He was discharged improved.@*Conclusion@#Pyoderma gangrenosum is a rare non-infectious cause of an ulcerative lesion in the lower extremity. Diabetes is a strong risk factor for this disease. The course is prolonged with the possibility of secondary infections. Upon histopathologic confirmation, an anti-inflammatory regimen could help improve outcomes.