Vitamin D Deficiency in Medical Inpatients: A Retrospective Study of Implications of Untreated Versus Treated Deficiency.

Vitamin D deficiency and insufficiency may further increase fracture risk in patients with decreased bone mineral density. A cross-sectional study on serum vitamin D concentrations in medical inpatients was conducted at Bassetlaw District General Hospital between April 2014 and January 2015 (10 months), and the relationship of serum vitamin D concentrations with calcium and alkaline phosphatase was evaluated. 25-Hydroxyvitamin D immunoassays were used and analyzed in the local laboratory. The total number of patients analyzed was 200, age range 18-99 years, with mean age of 76 years. The most common presentation was found to be fall/collapse. The following cutoff points for serum vitamin D were used: levels ≤30 nmol/L for severe deficiency, >30-50 nmol/L for moderate deficiency, >50-75 nmol/L for mild deficiency, and anything above 75 nmol/L as normal. Of the 209 participants examined, 78 (37.3%) participants had mild vitamin D deficiency, 54 (25.8%) participants had moderate vitamin D deficiency, 68 (32.5%) participants had severe vitamin D deficiency, and 9 (4.3%) participants with low vitamin D levels died during their admission. Of the 122 moderate/severe patients, 70 (57.4%) patients had their vitamin D deficiency treated, according to local Trust guidelines. The study found no relationship between serum calcium levels and vitamin D deficiency, whereas patients' alkaline phosphatase levels were found to be higher with increased severity of vitamin D deficiency. The study examined the implications of untreated severe/moderate vitamin D deficiency compared to treated deficiency, in terms of the frequency of readmission with similar complaints. It was found that the rate of readmission within one year in patients who were not treated was 57%, compared to 48% in patients whose vitamin D deficiency was treated. Presenting after falls was a recurring theme. It was concluded that even if moderate vitamin D deficiency can be asymptomatic, it is important to correct it as it can have an impact on morbidity and readmission rates in the long term.

Volume Measurements in Aortic Root Assessment Using Two-Dimensional Echocardiography.

BACKGROUND: Aortic dilatation is associated with the presence of aortic diseases. Current guidelines for assessing the aortic root (AoR) depend on linear measurements acquired by two-dimensional (2D) echocardiography. We considered that real-time three-dimensional echocardiography, which correlates better with AoR volume obtained by computed tomography, is widely unavailable, and therefore, there is a need to determine the AoR volume using 2D echocardiography. METHODS: Fifty-one consecutive apparently healthy volunteers were recruited and subsequently divided into three age groups. Specified planes of acquisition and previously defined landmarks were identified, and phases of the cardiac cycle that allowed for measurement standardization were used. Volume was determined by the modified Simpson's method. RESULTS: Although the average diastolic and systolic volume measurements of the AoR dimensions were not significantly different across the three age groups in the study population, a highly significant difference was observed in the volume measurements between male and female normotensive persons, P < 0.01 in each case. AoR volume measurements were five times in the diseased compared with the normotensive individuals; however, linear measurements were only 1.5 times in size of the normal individuals. Both point and interval estimates of the volume measurements of AoR in adult normotensives in three age groups were presented as baseline information. CONCLUSIONS: We hereby present a novel way to determine the AoR volume using 2D echocardiography and the normal reference range with respect to age and gender. We also established the relevance of our measurement by comparing the normal population with two isolated diseased aortas.

Spectrum of Echocardiographic Abnormalities among 168 Consecutive Referrals to an Urban Private Hospital in South-Western Nigeria.

Trans-thoracic echocardiography (TTE) is an important non-invasive cardiac examination that provides structural and functional information. It is useful in the diagnosis of cardiac diseases and often guides the management and follow-up of patients with cardiovascular diseases (CVD). The study aimed to present an audit of the echocardiograms performed in an urban private hospital over a two-year period in order to define the pattern of cardiac diseases in our center. Echocardiogram reports of 168 consecutive patients performed between May 2011 and April 2013 at an organized private sector hospital in Lagos, south-west Nigeria were reviewed. Studies were performed with a Toshiba Nemio XG ultrasound machine. The data obtained were analyzed for mean age, sex, clinical indications, and echocardiographic diagnosis in the study subjects. A total of 168 echocardiography reports were examined, comprising of 92 males (54.8%) and 76 females (45.2%). The age range of the subjects was 10-76 years (mean 42.5 ± 12.1 years). The commonest indication for echocardiography was systemic hypertension and hypertension related causes (38.1%), followed by abnormal resting electrocardiogram (14.9%). Routine annual medical screening was the next most common indication, representing 13.1% of the indications for echocardiography. The other indications are as presented in Table 1. The echocardiogram was normal in 64.3% of the subjects. The commonest abnormality detected was hypertensive heart disease (HHD); accounting for 9.6% of the subjects studied. Isolated atrial enlargement (left, right, or bi-atrial) was the next most common abnormality accounting for 6% of the echocardiographic diagnosis. Pulmonary hypertension was the next most common diagnosis accounting for 4.8% of our findings. The other echocardiographic diagnoses are as listed in Table 2. Hypertension represents the commonest indication for echocardiography. Normal echocardiogram was the commonest echocardiographic finding while HHD was the commonest echocardiographic abnormality. The prevalence of ischemic heart disease by echocardiography was 2.4%. There was no case of rheumatic heart disease (RHD). The prevalence of hypertrophic cardiomyopathy (HCM) was 1.2%. Ease of access to echocardiography may influence the findings in an echocardiographic audit and policy makers should incorporate appropriateness criteria into their guidelines for reimbursement.

Successful medical management of a left ventricular thrombus and aneurysm following failed thrombolysis in myocardial infarction.

We report the case of a patient with an extensive anterior myocardial infarction complicated by left ventricular systolic dysfunction, left ventricular apical thrombus and an apical left ventricular aneurysm following failed thrombolysis. We obtained serial two-dimensional echocardiograms at short intervals in the acute phase and also during the months of recovery and follow up. The patient was successfully and exclusively medically managed.