Leptin effect in the development of obesity -related hypertension in postmenopausal women

Obesity in humans causes hypertension, myocardial hypertrophy and coronary atherosclerosis, and increased cardiovascular morbidity and mortality that is thought to be related to sympathetic overactivity. Leptin is an adipocyte-derived hormone that acts in the hypothalamus to regulate appetite, energy expenditure and sympathetic nervous system outflow. One of the major mechanisms leading to the development of obesity-induced hypertension appears to be leptin-mediatedsympatho-activation. This study is done to evaluate the contribution of leptin in the development of obesity related hypertension in post menopausal women. A total number of 64 subjects [post menopausal women] included in the study were divided into obese hypertensive group [n= 38] and non obese non hypertensive group [n=26], age [57 +/- 4.5year] and [56 +/- 2.7year] respectively [mean +/- SD]. Obese hypertensive group defined as [BMI >/= 30 kg/m[2] and blood pressure >/= 140/90 mmHg with or without history of taking anti hypertensive medications and Non-obese non hypertensive group defined as [BMI < 30 kg/m[2]- blood pressure < 140/90 mmHg].In the present study leptin had been measured. Leptin level is higher in obese hypertensive group than in non obese non hypertensive group and it was 29.2 +/- 4 and 15.2 +/- 2.1[mean +/- SD] respectively and this difference is statistically significant with p value < 0.001. leptin may play a role in the development of obesity- related hypertension and may be an independent predictor of hypertension

Prevalence and outcome of bacterial endocarditis in patients with implantable cardiac device infections

Cardiac device infection [CDI] is a devastating complication of permanent pacemaker [PPM] or implantable cardioverter-defibrillators [ICD]. The incidence and outcome of endocarditis among patients with CDI is not well defined. The aim of this study was to report our experience in the prevalence, clinical presentations, and management of bacterial endocarditis [BE] among patients with CDI in a tertiary care cardiac center over a 25-year period. A total of 2630 cardiac devices implanted in a cohort of 2367 patients over 25 years were studied. Of these, 117 [4.4%] patients presented with CDI. Clinical, bacteriologic and both transthoracic [TTE] and transoesophageal echocardiographic [TEE] assessment were done. Of the 117 patients with CDI [90 males, age range 18-82 yrs, mean = 63 +/- 6 yrs], 87 [74%] had redo procedures [battery replacement in 50, repositioning of leads in 12, device extrusion in 15 or evacuation of significant haematoma in 10 patients]. Of these 87 patients, 65 had -re-implants on the same day of explantation. In 30 patients [26%] no apparent cause of PI was identified. Of the 117 patietns with CDI, 30 patients [26% of CDI and 1.1% of total procedures] had device-related BE with vegetations having appeared in all patients by TEE [15 DDD, 9VVI, 3 CRT and 3 ICD]. The clinical presentations were prolonged fever in 25 patients [83%], significant pulmonary hypertension with thrombo-embolism in 3 patients [10%], severe sepsis and multi-organ failure in 2 patients [6%]. Twenty-eight patients [93%] had positive blood cultures [S aureus in 23 [77%] and enterococci in 5]. There were only 2 patients with negative blood cultures. Device lead vegetations were evident in 20 patients [>10 mm diameter in 13 patients]. Ten patients presented with only right heart valve vegetations. Of the 30 BE patients, 28 [93%] had PI while 2 patients had no apparent cause but frequent intravenous injections [one drug addict and one on regular haemodialysis]. Of the 20 patients with lead endocarditis, 15 had their leads removed surgically with re-implantation of either epicardial [6 patients] or endocardial leads [9 patients]. Fifteen patients had only medical treatment with proper antibiotics [5 patients with lead BE and all 10 patients with valvular BE]. Four patients [13%] died; all had their devices implanted on same day of explanation. Cardiac device redo procedures are major risk factors for CDI, especially with re-implantation on the same day. Device related BE carries a serious morbidity and mortality, yet surgical removal of the whole system in the management of choice. Blood stream bacteraemia is a potential risk factor in patients with cardiac devices and warrants prophylaxis against BE