Association between Serum Lipid Profile and Renal Dysfunction in Patients with Heart Failure.

Renal dysfunction often accompanies heart failure which leads to an increase in hospitalization and mortality. The pathophysiological features have demonstrated that heart failure may cause reduction in cardiac output and decrease in renal perfusion, which leads to development of chronic renal disease. Thus, more attention should be paid to the associated risk factors with the aim to reduce the prevalence, hospitalization and mortality. According to recent studies, dyslipidemia has become one of the key risk factors which leads to progression of renal dysfunction in heart failure patients. MATERIAL: 105 hospitalized heart failure patients with left ventricular ejection fraction (LVEF) ≤ 45%, and New York Heart Association (NYHA) class II -IV were enrolled for a study period of 6 months, that is from March 2021 to August 2021.The estimated glomerular filtration rate (eGFR) <90 mL/min/1.73m2 was defined as renal dysfunction. Heart failure was confirmed clinically and with the echocardiography report. Significant cognitive impairment and life threatening comorbidity were the main exclusion criteria. OBSERVATION: Among the 105 patients with heart failure, a total of 59 (56.2%) had renal dysfunction, and 46 (43.8%) did not have renal dysfunction. The high density lipoprotein cholesterol (HDL-C) and the left ventricular ejection fraction (LVEF) were found to be positively correlated with estimated glomerular filtration rate (eGFR) (p<0.05), that is, were significantly lower in those patients with renal dysfunction than those patients without renal dysfunction. The total cholesterol (TC), triglyceride, low density lipoprotein cholesterol (LDL-C) showed no significant difference between the patients with renal dysfunction and those without renal dysfunction. CONCLUSION: Among the lipid profile of TC, triglyceride, LDL-C, HDL-C, the HDL-C is the only lipid factor significantly associated with renal dysfunction in hospitalized heart failure patients.

Clinical Characteristics and Metabolic Profiles of Non-Alcoholic Fatty Liver Disease (NAFLD) in Lean Patients and Their Comparison with Obese and Overweight NAFLD.

Non -alcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease throughout the world. The spectrum of NAFLD includes a non-serious condition called fatty liver, a more serious condition named non-alcoholic steatohepatitis (NASH) which may lead to severe liver scarring and cirrhosis. Obesity and diabetes mellitus are established risk factors for NAFLD. However, it has been increasingly reported among lean or non-obese and non diabetic patients. The aim of this study was to evaluate the magnitude, clinical and metabolic profiles of NAFLD in normal body mass index (BMI) subjects, defined as lean NAFLD, as compared to overweight or obese NAFLD and lean healthy controls. MATERIAL: 92 consecutive NAFLD and 90 healthy controls were studied between 2021 March to 2021 August, for a period of 6 months. Patients of NAFLD were diagnosed on the basis of ultrasonography features, presence of metabolic syndrome or insulin resistance. Patients with a BMI of less than 23 kg/m2 were defined as lean NAFLD. Alcoholic patients, those with liver diseases of other known causes, patients on medications known to induce fatty liver were excluded. For comparing the characteristics of lean NAFLD patients, we also included 90 lean healthy subjects with normal liver on ultrasonography as control subjects. OBSERVATION: Among the 92 NAFLD patients, 18 (19.56%) were lean or non-obese, while 48 (52.17%) were obese, and 26 (28.26%) were overweight. The lean NAFLD cohort was younger (p<0.001), more commonly female, had a lower prevalence of diabetes (p=0.01) and metabolic syndrome (p<0.001). The serum lipid profile was similar in all the three BMI categories and 82% of the lean NAFLD were dyslipidemic. In comparison to obese subjects, patients with lean NAFLD had significantly less fibrosis. Despite being lean, the mean BMI of lean NAFLD patients was still higher than healthy control group. CONCLUSION: Dyslipidemia is frequently associated with lean NAFLD. Lean NAFLD when compared to obese or overweight NAFLD, have lower prevalence of type 2 diabetes mellitus, metabolic syndrome and less fibrosis on fibroscan of liver. They donot have abdominal obesity, but their BMI was higher than healthy controls.

Bimatoprost in Dermatology.

Bimatoprost is a prostamide analogue used for treatment of glaucoma in ophthalmology. Surprisingly, the side effects such as increased pigmentation of eyelids and hypertrichosis in patients being treated with prostaglandin analogues for glaucoma have opened new areas of application in various dermatological disorders such as alopecia mainly affecting eyelashes, eyebrows, and vitiligo.

Community-based management of severe acute malnutrition in India: new evidence from Bihar.

BACKGROUND: An estimated one-third of the world's children who are wasted live in India. In Bihar state, of children <5 y old, 27.1% are wasted and 8.3% have severe acute malnutrition (SAM). In 2009, Médecins Sans Frontières (MSF) initiated a community-based management of acute malnutrition (CMAM) program for children aged 6-59 mo with SAM. OBJECTIVE: In this report, we describe the characteristics and outcomes of 8274 children treated between February 2009 and September 2011. DESIGN: Between February 2009 and June 2010, the program admitted children with a weight-for-height z score (WHZ) <-3 SD and/or midupper arm circumference (MUAC) <110 mm and discharged those who reached a WHZ >-2 SDs and MUAC >110 mm. These variables changed in July 2010 to admission on the basis of an MUAC <115 mm and discharge at an MUAC ≥120 mm. Uncomplicated SAM cases were treated as outpatients in the community by using a WHO-standard, ready-to-use, therapeutic lipid-based paste produced in India; complicated cases were treated as inpatients by using F75/F100 WHO-standard milk until they could complete treatment in the community. RESULTS: A total of 8274 children were admitted including 5149 girls (62.2%), 6613 children aged 6-23 mo (79.9%), and 87.3% children who belonged to Scheduled Caste, Scheduled Tribe, or Other Backward Caste families or households. Of 3873 children admitted under the old criteria, 41 children (1.1%) died, 2069 children (53.4%) were discharged as cured, and 1485 children (38.3%) defaulted. Of 4401 children admitted under the new criteria, 36 children (0.8%) died, 2526 children (57.4%) were discharged as cured, and 1591 children (36.2%) defaulted. For children discharged as cured, the mean (±SD) weight gain and length of stay were 4.7 ± 3.1 and 5.1 ± 3.7 g · kg(-1) · d(-1) and 8.7 ± 6.1 and 7.3 ± 5.6 wk under the old and new criteria, respectively (P < 0.01). After adjustment, significant risk factors for default were as follows: no community referral for admission, more severe wasting on admission, younger age, and a long commute for treatment. CONCLUSIONS: To our knowledge, this is the first conventional CMAM program in India and has achieved low mortality and high cure rates in nondefaulting children. The new admission criteria lower the threshold for severity with the result that more children are included who are at lower risk of death and have a smaller WHZ deficit to correct than do children identified by the old criteria. This study was registered as a retrospective observational analysis of routine program data at http://www.isrctn.com as ISRCTN13980582.