RESUMEN
In view of the high morbidity and mortality of patients with congestive heart failure, early diagnosis is of paramount importance. To assess the diagnostic and prognostic utility of plasma levels of the NT-Pro BNP in patients presenting with heart failure this study was carried out. This cross-sectional study was performed on patients with heart failure admitted in the cardiology ward of Taleghani Medical Center during a certain period from 2005- 2006. Subjects with acute coronary syndrome, hyperthyroidism, renal failure [GFR<60], severe valvular stenosis, severe pulmonary disease, ARDS, hepatic cirrhosis, primary hyperaldosteronism and the candidates for heart transplant were excluded from the study. Blood samples were collected and plasma levels of NT-Pro BNP were measured by ELISA method [Biomedica- crop, Bratislava Slovakia]. Results were documented and analyzed using SPSS software. Mann- Whitheny and KrusKall-Wallis tests were utilized for analysis. Values were analyzed for confounding variables [e.g age, sex, blood pressure, and ischemic heart disease and NYHA class]. 79 patients full filled the criteria of inclusion. 70% were males and mean age of patients was 63 +/- 14 years. Mean plasma NT-Pro BNP level was 421 +/- 387. In subjects <60 years of age, the mean levels were 309 +/- 300, and among those >/= 60 years it was 486 +/- 419, [P<0.05]. With advancing clinical stage, the mean plasma level of NT-Pro BNP increased 6 folds, [p<0.01], whereas with advancing NYHA class it increased 4 folds [P<0.01]. It seems that plasma NT-Pro BNP level is a suitable indicator of the severity of heart failure
Asunto(s)
Humanos , Masculino , Femenino , Péptido Natriurético Encefálico , Insuficiencia Cardíaca/diagnóstico , Diagnóstico Precoz , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , PronósticoRESUMEN
It is frequently thought that lumbar puncture [LP], is a mandatory procedure in all children presenting with febrile convulsion since convulsion may be the sole clinical manifestation of bacterial meningitis. The present study was conducted to assess whether meningitis could be recognized using readily available clinical information. During the study period, 254 previously healthy children aged 6 months to 5 years were brought consecutively to the pediatric department of a teaching university hospital after their first febrile convulsion. Lumbar puncture [LP] was performed in all cases. Children with febrile convulsion and meningitis served as cases and those with febrile convulsion in the absence of meningitis, served as controls. The following factors were compared between groups: age, lethargy, irritability, vomiting, nuchal rigidity, bulging fontanel, headache, drowsiness, toxicity, coma, complex seizure, and prior antibiotic use.Of 245 infants, 12[4.7%] had meningitis. The following risk factors were significantly associated with meningitis: lethargy [p<0.0006], irritability [p<0.0008], vomiting [p<0.0001], nuchal rigidity [p<0.0001], bulging fontanel [p<0.05], headache [p<0.006], drowsiness [p<0.0001], toxicity [p<0.0012], coma [p<0.005], complex seizure [p<0.04], and prior antibiotic use [p<0.0002]. All children with meningitis had at least one of the following risk factors: prior antibiotic use, positive clinical manifestations. Our results indicate that clinical manifestations and type of convulsion [simple or complex] could be used to diagnose meningitis, thus, there is no need for routine [LP] in all children who present with fever and seizure. However a lumbar puncture is mandatory in infants younger than 12 months or those who have received prior antibiotics