Endothelial function in macrovascular and microvascular circulation is significantly impaired in moderate to severe OSA patients without comorbidities. These patients also show evidence of subclinical atherosclerosis, in the form of increased CIMT.
This study aims to evaluate the role of cardiac enzymes N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin-I (CTnI) as predictors of outcomes in patients with sepsis.78 cases with a diagnosis of sepsis were enrolled over a 2-year period. Baseline demographic, Acute Physiology and Chronic Health Evaluation-II (APACHE-II), Simplified Acute Physiology Score-II (SAPS-II), hematologic and biochemical parameters were noted. Serum NT-proBNP and CTnI were evaluated at 24 and 72 hours of admission along with echocardiography. Patients were prospectively followed up until death or discharge.Mean APACHE-II score was 19.8±9.6 and SAPS-II was 44.8±17.2. Survival rate in the study was 47.5% (36 of 78 patients). NT-proBNP was significantly higher in non-survivors with values over 4300 pg/mL at 24 hours and 5229 pg/mL at 72 hours associated with poor outcomes (p<0.05). CTnI was higher among non-survivors than in survivors, but the difference was not significant. APACHE-II score combined with NT-proBNP predicted a poor outcome in 51.2% cases compared with 14.6% cases with APACHE-II alone (p<0.05), while SAPS-II combined with NT-proBNP predicted a poor outcome in 53.6% cases as compared with 9.6% cases with SAPS-II alone (p<0.05). SAPS-II greater than 45 and NT-proBNP values at 72 hours were independent predictors of mortality in patients with sepsis.NT-proBNP is an independent predictor of mortality in patients with sepsis and its combination with APACHE-II and SAPS-II improves the predictive values of the scoring systems.
Heart failure (HF) may be a presenting manifestation of a few endocrine disorders and should be considered in evaluation of heart failure causes. This clinically oriented review is an attempt to highlight the protean manifestations of heart failure in endocrine diseases which could present either as acute or chronic heart failure. Acute heart failure manifests as hypertensive crisis, Takotsubo syndrome, or as tachy/brady cardiomyopathies. Chronic heart failure could masquerade with features of hyperdynamic heart failure, or hypertrophic, restrictive or dilated cardiomyopathy. Rarely constrictive features or resistant heart failure could be the presenting feature. Isolated presentation as pulmonary hypertension and right heart failure are also documented. Good history-taking and physical examination with targeted investigations will help in the timely management for reversing the pathophysiology to a significant extent by appropriated management.
Aims: To determine the prevalence of depression and anxiety in Indian patients undergoing CABG surgery and their relationship to physical activity and quality of life. Methods: 121 patients undergoing CABG surgery between November 2017 and May 2019 were included. The Hospital Anxiety and Depression Scale (HADS) was employed for the assessment of depression and anxiety. Health-related quality of life was assessed using the SF-36 questionnaire. The short form of the International Physical Activity Questionnaire (IPAQ) was used for assessment of physical activity. Participants were categorized into high, moderate or low physical activity. Results: The overall prevalence (95% CI) of depression and anxiety was 70.5% (0.61-0.78) and 64.6% (0.55-0.73) respectively. When a cut-off score of 11 instead of 8 was used on the HADS [Borderline cases excluded (HADS score 8-10)], the prevalence of depression and anxiety was 31.3% (0.22-0.40) and 40.7% (0.31-0.50) respectively. Patients with low levels of physical activity had a higher prevalence of depression and anxiety (p < 0.05). Patients with depression demonstrated a worse quality of life compared to those without depression in all domains measured by the SF-36 questionnaire. Among patients with anxiety, quality of life was worse in four out of the eight domains measured by the SF-36 questionnaire. Conclusion: Indian patients undergoing CABG surgery have a high prevalence of depression and anxiety. Patients with depression and anxiety were found to have low physical activity and poor quality of life when compared to their counterpart.
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