ABSTRACT
It is well known that chronic kidney disease (CKD) is associated with significant morbidity and mortality, predominantly due to cardiovascular complications. Recent literature report pulmonary hypertension (PH) as a common accompaniment of CKD and in majority of these cases, secondary causes of PH are not evident. In this study, we looked at the prevalence and possible risk factors of PH in stage 5 CKD patients with a special focus on unexplained PH. In this cross-sectional study, 100 stage 5 CKD patients [50 each on maintenance hemodialysis (HD) and conservative management] were included. After baseline investigations participants underwent two-dimensional transthoracic echocardiogram. The routine method of PH diagnosis based on modified Bernoulli's formula was complemented with an alternate method based on pulmonary artery acceleration time (PAAT). Detailed workup for secondary causes was carried out in patients with PH. The prevalence of PH in the study population was 89% (56% mild, 35% moderate, and 9% severe). Asymptomatic left ventricular diastolic and systolic dysfunction were noted in 54% and 20%, respectively. Significant association with PH was found with the duration of CKD, systolic and diastolic Blood pressure, hemoglobin, transferrin saturation, maintenance HD, and dialysis vintage. In sharp contrast to the existing data this study showed a very high prevalence of PH though severe PH was present only in 9%. The inclusion of PAAT-based method enabled the detection of more cases of PH. Further evaluation carried out for common secondary causes did not show significant abnormalities except for a sizeable proportion with asymptomatic left ventricular dysfunction.
Subject(s)
Hypertension, Pulmonary , Kidney Failure, Chronic , Renal Insufficiency, Chronic , Humans , Hypertension, Pulmonary/diagnostic imaging , Hypertension, Pulmonary/epidemiology , Cross-Sectional Studies , Kidney Failure, Chronic/complications , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Blood Pressure/physiology , Prevalence , Risk FactorsABSTRACT
A 68-year-old woman presented with chest pain and loss of consciousness following an anterior wall myocardial infarction. Magnetic resonance imaging of brain showed features of hypoxic brain injury. She subsequently developed memory deficits, drowsiness and behavioral changes. Magnetic resonance imaging of brain done 4 months after ischemic insult showed evidence of delayed posthypoxic leukoencephalopathy also known as Grinker's myelinopathy.
ABSTRACT
OBJECTIVE: To measure visceral fat (VF) in over nourished children (6-15 y) by ultrasonography (USG) and to find relation between anthropometric measurements (AM) and VF in these children. This case series included 113 children of 6-15 y with Body Mass Index (BMI) >85th centile who attended the nutrition clinic of a tertiary care centre in rural Kerala from January 2009 through June 2010. METHODS: After recording the base line demographic parameters and anthropometric measurements, VF was assessed by USG. Relation between VF and anthropometric measurements were assessed by correlation. Measurements which showed significant positive correlation were further analyzed by linear regression. RESULTS: The mean total VF was 145.63 (SD = 25.37) mm. Total VF increased with age. Significant positive correlation was found for weight, height, BMI, hip circumference (HC) and waist circumferences (WC). WC showed maximum correlation. The best predictor of VF was WC. CONCLUSIONS: The total VF in over nourished children increases with age. Even though the most important predictor of visceral fat is WC, it has a low predictive power.
