Frequency of Hypoalbuminemia and In-Hospital Mortality in Acute Ischemic Stroke Patients Presenting at a Tertiary Care Hospital, Hyderabad.

Background The aim of this study was to determine the frequency of hypoalbuminemia and in-hospital mortality in acute ischemic stroke patients at a tertiary care hospital in Hyderabad. Methodology This was a prospective observational study conducted at the Department of Medicine, Isra University Hospital, Hyderabad, from February 17, 2017 to August 18, 2017. A total of 196 consecutive cases of acute ischemic stroke were included. Hypoalbuminemia was defined as serum albumin of <3.5 mg/dL. In-hospital outcome in terms of survival or death within seven days of admission was assessed and recorded. Data were analyzed using SPSS, version 20.0. (IBM Corp., Armonk, NY, US). Chi-square test was applied, and p-value of ≤0.05 was considered significant. Results Out of the 196 acute ischemic stroke cases, 146 (74.5%) were males and 50 (25.5%) were females. The mean age was 49.31 ± 10.46 years. A total of 90 (45.9%) cases had hypoalbuminemia. Out of these 196 cases, 22 (11.2%) expired within seven days of presentation of acute ischemic stroke, and out of these 22 expired cases, 18 (81.8%) had hypoalbuminemia. In-hospital mortality was found to be strongly associated with hypoalbuminemia (p < 0.001). Conclusions Frequency of hypoalbuminemia was significantly higher in ischemic stroke patients and was found to be associated with in-hospital mortality, warranting monitoring at regular intervals, as well as recognizing and treating it early for risk stratification.

Results of a retrospective multicenter trial of the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation.

PURPOSE: To report the results of a multicenter experience with the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt (TIPS) creation in which patency and clinical outcome were evaluated. MATERIALS AND METHODS: One hundred consecutive patients with portal hypertension, with a mean age of 52 years (range, 22-86 years), underwent implantation of the Viatorr TIPS stent-graft at one of three hospital centers. The indications for TIPS creation were variceal bleeding (n = 81) and refractory ascites (n = 19). Twenty patients had Child-Pugh class A disease, 46 had class B disease, and 34 had class C disease. Eighty-seven patients underwent de novo TIPS placements, with 13 treated for recurrent TIPS stenosis. Sixty-two patients were available for follow-up portal venography and portosystemic pressure gradient (PSG) measurement commencing 6 months after Viatorr stent-graft placement. RESULTS: The technical success rate was 100%. TIPS creation resulted in an immediate decrease in mean PSG (+/-SD) from 21 mm Hg +/- 6 to 7 mm Hg +/- 3. Acute repeat intervention (within 30 days) was required for portal vein thrombosis (n = 1), continued bleeding (n = 3), and encephalopathy (n = 1). The all-cause 30-day mortality rate was 12%. Two patients developed acute severe refractory encephalopathy, which led to death in one case. New or worsening encephalopathy was identified in 14% of patients. The incidence of recurrent bleeding was 8%. The cumulative survival rate at 1 year was 65%. Sixty-two patients available for venographic follow-up had a mean PSG of 9 mm Hg +/- 5 at a mean interval of 343 days (range, 56-967 days). There were four stent-graft occlusions (6%) and seven hemodynamically significant stenoses (11%), four within the stent-graft and three in the non-stent-implanted hepatic vein. The primary patency rate at 1 year by Kaplan-Meier analysis was 84%. CONCLUSIONS: This retrospective multicenter experience with the Viatorr stent-graft confirms the preliminary findings of other investigators of good technical results and improved patency compared with bare stents. Early mortality and symptomatic recurrence rates are low by historical standards. The theoretical increase in TIPS-related encephalopathy was not demonstrated. Longer-term follow-up will be required to determine whether the additional cost of the Viatorr stent-graft will be offset by reduced surveillance and repeat intervention.

Precursors of atherosclerosis in a random sample from a Hellenic population: the Athens Study.

BACKGROUND: Atheromatosis, the principal lesion in atherosclerotic cardiovascular disease, is associated with increased levels of blood pressure, serum cholesterol, cigarette smoking and other variables. As these lesions are thought to appear first in childhood, this study was designed to assess the levels of these atherosclerotic precursors in children living in Athens, Greece. METHODS: The following parameters were measured in a random sample of 4117 school children aged 6-18 years, living in the centre of Athens: body mass index, blood pressure, serum lipids, glucose, uric acid, calcium, phosphorus, creatinine, and haematocrit. RESULTS: Mean levels of blood pressure, total cholesterol, cigarette smoking and body mass index increased with age in both sexes, levels being similar to those of children in developed countries. Smoking started at elementary school, and by puberty had reached adult levels. High levels of systolic blood pressure ( > or = 130 mmHg) and total cholesterol ( > or = 5.68 mmol/l) were seen in 22% and 13% of children respectively. Triglyceride and glucose levels did not increase with age; high-density lipoprotein cholesterol decreased and uric acid increased from 14 to 18 years, but only in boys. Levels of body mass index, total cholesterol, triglycerides, high-density lipoprotein and uric acid above the mean population values were found in 25% of children, and glucose levels above the mean in 50%. Multiple linear regression analysis showed a positive correlation between systolic blood pressure and age, body mass index, uric acid, sex, glucose, triglycerides and high-density lipoprotein cholesterol (in that order), and between diastolic blood pressure and age, body mass index and triglycerides. CONCLUSIONS: These findings indicate that the levels and prevalence of precursors of atherosclerosis are higher than expected in a southern European population, and are similar to those found in developed countries. This would indicate a need for greater awareness among the Greek population of preventive measures against developing cardiovascular disease.