BACKGROUND Heart failure is one of the leading causes of morbidity and mortality in the Populations across the globe, as it is a common end point of many diseases viz. coronary artery diseases, cardiomyopathies, hypertension and many others enumerated in the forthcoming sections. So methodical management of this ailment will play a vital role in preventing unnecessary mortality and morbidity. Lot of research has been done in relation to better understanding of the pathophysiology of this disease as well as in the diagnostic and therapeutic techniques related to heart failure till date. Echocardiography in particular, has revolutionised the diagnosis of heart failure. In the forthcoming sections is on a very simple and quick method of diagnosis of heart failure viz. NT-pro BNP level estimation, which neither needs the echocardiography gadgets nor a skilled echotechnician/cardiologist to interpret the echocardiographic images. This might prove very handy, especially in situations where cardiologists and echocardiography are not accessible. Apart from diagnosis, it may as well be used for followup as well as for prognostication. So, efforts are towards making diagnosis of heart failure simpler. MATERIALS AND METHODS Patients admitted in Cardiology Ward, K R Hospital, attached to Mysore Medical College and Research Institute between January 2015 and August 2016 with reduced left ventricular ejection fraction on 2D echocardiography were selected as cases. Forty patients diagnosed with congestive cardiac failure were selected as the cases; 40 subjects with normal 2D echocardiography with normal renal function tests, normal Hb%, normal BMI were selected as controls. RESULTS The median value of NT pro-BNP was 2294 pg/mL in a total of 11 cases of acute heart failure. The median value was 3450 pg/mL in 29 patients with chronic heart failure. The median of acute and chronic heart failure cases taken together was 3193 pg/mL. Among the controls, the median value was < 20 pg/mL. Clearly, the cases had elevated blood levels of NT pro-BNP as compared to controls. Chronic cases had higher values of 60% of patients having breathlessness more for more than 1 year had NT pro-BNP values greater than 2000 pg/mL and majority of them had values > 10,000 pg/mL; 57% of patients with breathlessness of duration of 1-12 months had values > 2000 pg/mL and majority of them had values between 2000-10,000 pg/mL; 50% of the patients having breathlessness for 1 to 4 weeks had values between 1000-2000 pg/mL; 71% of patients with Grade 4 NYHA failure had NT pro-BNP values above 2000 pg/mL; 55% of patients with Grade 3 NYHA failure had NT pro-BNP values of 2000 pg/mL and 45% of Grade 3 NYHA failure had NT pro-BNP values between 100-2000 pg/mL; 50% each of patients with Grade 2 NYHA failure had values below and above 2000 pg/mL; 78% of the patients with LVEF < 30% had NT pro-BNP levels > 2000 pg/mL, 22% cases had values < 2000 pg/mL; 37% of patients with EF of 30%-40% had > 2000 pg/mL, 63% of patients with LVEF 31%-40% had NT pro-BNP levels < 2000 pg/...
BACKGROUND Prevalence of metabolic syndrome in India is 30.07%. India has the second maximum number of diabetic patients in the whole world. C-reactive protein and uric acid has been linked to pathogenesis and progression of diabetes and metabolic syndrome. Uric acid and highly sensitive C-reactive protein (hs-CRP) each now share a respected inclusion as two of the novel risk markers-risk factors associated with the metabolic syndrome. The objective of the study is to assess the level of uric acid and CRP in metabolic syndrome subjects and to compare the levels in metabolic syndrome subjects with and without diabetes mellitus. MATERIALS AND METHODS Relevant data obtained from Subjects attending OPD and from the in-patients of Department of Medicine in K. R. Hospital, Mysore, who satisfy the inclusion and exclusion criteria, was studied for a period from 2015 January to December 2015. The subjects were explained about the study and informed written consent was taken from all the subjects. A pre-structured Performa was used to collect the baseline data. Detailed history and clinical examination, routine investigations and the following investigations serum triglycerides, HDL, LDL, FBS, serum uric acid, CRP (CRP was measured as hs-CRP test) were collected. RESULTS Mean uric acid value in metabolic syndrome was 6.1±1.75 mg/dL, which was in the upper limit of normal. Mean uric acid level in diabetics was 6.15±1.81 mg/dL and in non-diabetics it was 6.05±1.71 mg/dL. It does not show any significant difference between diabetics and non-diabetics. Males had uric acid level of 6.15±1.81 mg/dL and females had 6.05±1.71 mg/dL. There was no significant difference in uric acid levels in males and females (p = 0.775) in the study; 56% of diabetics had higher uric acid (> 6 mg/dL) and 46% of non-diabetics had uric acid > 6 mg/dL. Those with higher uric acid levels had significantly higher systolic blood pressure (p = 0.027) and FBS (p = 0.033) than those with lower uric acid levels; 76% of patients had hs-CRP > 3 mg/L and none of the patients had hs-CRP < 1 mg/L. Among diabetics, 64% had higher hs-CRP level (> 3 mg/L), while in non-diabetics 88% had hs-CRP > 3 mg/L and high hs-CRP level are significantly more associated with non-diabetics (p = 0.005) than diabetics. In those with uric acid > 6 mg/dL, 78.4% had hs-CRP > 3 mg/L. CONCLUSION By monitoring uric acid and hs-CRP levels, we can classify the risk and severity of metabolic syndrome. Uric acid at higher level of normal range as seen in the present study will not get clinically treated most of the time. Now uric acid is neither a target of treatment in asymptomatic hyperuricaemia nor a risk marker in clinical practice. Treating this can decrease the progression of metabolic syndrome. Better and more strict lifestyle changes and interventions can be implemented in those with higher uric acid and hs-CRP levels, so that we can prevent complications of metabolic syndrome, specifically atherosclerotic cardiovascular complications.
BACKGROUNDThe number of people living with HIV/AIDS is on the rise, so are the problems like renal dysfunction which needs to be addressed. The study was aimed at providing data regarding prevalence and the association of certain modifiable and non-modifiable factors with renal function.
BACKGROUND Hypertension with chronic kidney disease is a widely prevalent public health concern. Calcium channel blockers are a commonly used class of drugs for the treatment of hypertension. L-type calcium channel blockers like amlodipine cause a reflex sympathetic overactivity, which predisposes to increased cardiovascular morbidity and mortality. Also, the effect of L-type CCBs on urinary protein excretion is uncertain. Cilnidipine is a novel CCB with a dual L/N-type calcium channel blocking property, thus favouring additional renal and cardiovascular protection. The objective of this study is to evaluate the effects and their linearity across the timeframe of amlodipine and cilnidipine in hypertensive subjects with proteinuria on heart rate, blood pressure, lipid profile and proteinuria. MATERIALS AND METHODS After Institutional Ethical Committee approval, a prospective, randomised and open-label study was carried out on hypertensive subjects with proteinuria attending the General Medicine OPD in K. R. Hospital, Mysore. Sixty subjects satisfying the inclusion and exclusion criteria were included in the study. Heart rate, blood pressure, lipid profile (TC, LDL, HDL, TG) and Urine Protein-to-Creatinine Ratio (UPCR) were measured at baseline. Blood pressure and heart rate were monitored at weekly intervals until the end of 12 weeks. While lipid profile was reassessed at 6 weeks and 12 weeks, UPCR was reassessed at the end of 12 weeks. Descriptive statistics, independent sample 't' test, repeated measure ANOVA and Cramer's V test were used to analyse the results. RESULTS Demographic profile was well matched in both the groups. In the Amlodipine group, the heart rate was significantly higher tha n that before treatment, whereas subjects in the cilnidipine group had a significantly lower heart rate when compared to baseline (p < 0.05). There was no significant difference in mean SBP and mean DBP values, either within each group or between the two groups. Also, the UPCR was significantly decreased in the cilnidipine group as opposed to the amlodipine group where it wa s significantly increased, thereby resulting in a significant intergroup difference (p < 0.05). However, neither of the drugs caused a significant change in the lipid parameters and the intergroup difference was also statistically insignificant. CONCLUSION Cilnidipine is thus, a better alternative in hypertensive patients with proteinuria due to its cardioprotective and renoprotective actions.
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