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Resumo Fundamento: A síndrome dos ovários policísticos (SOP) é a doença endócrino-metabólica mais comum em mulheres em idade reprodutiva, e ocorre em uma a cada 10 mulheres. A doença inclui irregularidade menstrual e excesso de hormônios masculinos e é a causa mais comum de infertilidade em mulheres. A dispneia é um sintoma frequente e muitas vezes acredita-se que seja decorrente da obesidade, mas não se sabe se é decorrente de disfunção cardíaca. Objetivo: Avaliar o acoplamento ventrículo-arterial (VDAP) e a rigidez arterial pulmonar em pacientes com SOP. Métodos: Foram incluídos 44 pacientes com SOP e 60 controles; amostras de sangue venoso foram coletadas para exames laboratoriais e ecocardiograma transtorácico 2-D, Modo-M e com Doppler tecidual foram realizados em todos os participantes. Um valor de p

Prashanth Rajagopalan,1 Georgi Abraham,2 Yuvaram NV Reddy,2 Ravivarman Lakshmanasami,1 ML Prakash,1 Yogesh NV Reddy2 1Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, 2Department of Nephrology, Madras Medical Mission Hospital, Chennai, India Abstract: This population-based prospective study was undertaken in Mahatma Gandhi Medical College to estimate the renal function in young healthy Indian adults. A young healthy heterogeneous Indian cohort comprising 978 individuals, predominantly medical students, was assessed by a detailed questionnaire, and variables such as height, weight, body mass index (BMI), birth weight, and blood pressure were documented. Laboratory investigations included serum creatinine, serum cystatin C, blood sugar, urine protein, and imaging of the kidneys with ultrasound. The mean age of the cohort was 25±6years, comprising 672 males and 306 females. The estimated glomerular filtration rates (eGFRs) by the Cockcroft–Gault formula for BMI

Patients with heart failure (HF) and reduced ejection fraction (HFrEF) display exercise intolerance measured objectively as decreased peak oxygen uptake (VO2).1 In accordance with Fick’s principal and law of diffusion, reduced peak VO2 is the result of impaired convective and diffusive O2 transport.2,3 Endurance training improves peak VO2 in clinically stable HFrEF patients secondary to central and peripheral adaptations that result in increased cardiac output and O2 distribution and extraction in skeletal muscle.1 We report, using invasive hemodynamic and pulmonary gas exchange measures, exercise changes in VO2 and its determinants in an avid cyclist with severe cardiac limitation because of advanced HFrEF. A 55-year-old male patient who had been a lifelong marathon runner was diagnosed with idiopathic nonischemic dilated cardiomyopathy 5 years before evaluation. He had a history of atrial fibrillation and was on optimal doses of carvedilol, lisinopril, and spironolactone. His ejection fraction was 20% to 25%, but he had remained in New York Heart Association class I and was able to continue cycling and intense daily exercise. In the past year, he was hospitalized twice for acutely decompensated HF, with gradually worsening effort intolerance. Given the increasing need for hospitalization, he was referred for invasive exercise testing as part of a transplant evaluation workup. Laboratories revealed hemoglobin 13.3 g/dL, creatinine 1.5 mg/dL, sodium 132 mmol/L, troponin 0.06 ng/mL, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) 14 080 pg/mL. Echocardiography showed ejection …

The aim of this retrospective study was to compare the prevalence of pulmonary hypertension in a cohort of patients with end-stage renal disease (ESRD) prior to and following renal transplantation and to identify the possible risk factors. Of the 425 renal transplantations performed between 2001 and 2007, Doppler echocardiographic findings were available in 124. The echocardiographic data, collected both pre- and post-transplant, included the pulmonary artery pressure (PAP), ejection fraction and left ventricular hypertrophy. The data analyzed included age, gender, hypertension, diabetes, smoking status, along with blood urea, creatinine, glomerular filtration rate, hemoglobin, hemodialysis duration, urine albumin, arterio-venous access and body mass index (BMI). Chi-square test was used for discrete variables and ANOVA was used for continuous variables. Of the patients studied, males comprised 72%; the mean age was 43.3 ± 13.02 years; 87% were hypertensive, 30% were diabetic and 4% were smokers. Statistical analysis revealed a significant reduction of the PAP, irrespective of its severity, following renal transplantation (P

Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN (C.T.L., Y.N.R.); Advisor to residents and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.R.B.). A 62-year-old woman presented to the emergency department after a mechanical fall onto her left hip. She had been in her usual state of health earlier that day, but after the fall she experienced intractable leg pain and was unable to bear weight on her left hip. She reported no chest pain, dyspnea, palpitations, light-headedness, or dizziness before the event. Her medical history was notable for hypertension and nicotine and alcohol dependence. Her initial physical examination revealed evidence of severe left hip tenderness and pain with motion. The remainder of her examination findings were unremarkable. Radiography of the left hip revealed a left intertrochanteric hip fracture with minimal displacement. She underwent prompt surgical repair with internal fixation using a cephalomedullary nail. The patient tolerated the procedure well with no complications and minimal blood loss. Postoperatively, she received deep venous thrombosis prophylaxis with subcutaneous heparin. Her pain subsided considerably after the operation. At 36 hours postoperatively, the patient experienced sudden shortness of breath with severe respiratory distress. On examination, she was somnolent and had a blood pressure of 90/54 mm Hg and a heart rate of 131 beats/min. She was tachypneic (respiratory rate, 20 breaths/min) and hypoxic (oxygen saturation, 90% with a face mask delivering 40% fraction of inspired oxygen). The patient was afebrile and drowsy but was able to follow commands. Cardiac examination revealed a right ventricular (RV) precordial heave, elevated jugular venous pressure, and cool extremities with a weakly palpable pulse. Auscultation identified a right-sided third heart sound but no murmurs. Lung examination revealed diffuse bilateral crackles but no decreased breath sounds at the base or dullness to percussion suggestive of a pleural effusion. She had bilateral mild pitting edema on the lower

Kidney transplant recipients may develop new-onset diabetes after transplantation (NODAT) and transplant-associated hyperglycemia (TAH) (NODAT or new-onset impaired glucose tolerance-IGT). We studied 251 consecutive renal transplant South Asian recipients for incidence of NODAT and its risk factors between June 2004 and January 2009. Pre-transplant glucose tolerance test (GTT) identified non-diabetics (n = 102, IGT-24, NGT-78) for analysis. Baseline immunosuppression along with either cyclosporine (CsA) (n = 70) or tacrolimus (Tac) (n = 32) was given. Patients underwent GTT 20 days (mean) post-transplant to identify NODAT, normal (N) or IGT. TAH was observed in 40.2% of the patients (40% in CsA and 40.6% in Tac) (P = 0.5). NODAT developed in 13.7% of the patients (12.9% in CsA and 15.6% in Tac) (P = 0.5). Overall, Hepatitis C (P = 0.007), human leukocyte antigen (HLA) B52 (P = 0.03) and lack of HLA A28 (A68/69) (P = 0.03) were associated with TAH. In the Tac group, higher Day 1 dosage (P

The aim of this study was to assess incidence and risk factors for acute kidney injury (AKI) in patients with dengue fever (DF). A total of 223 patients (males, 130; females, 93; mean age, 26.2 ± 18.2 years) from a tertiary care centre in southern India were retrospectively analysed. Acute renal failure (ARF) developed in 24 (10.8%) patients. Based on the Acute Kidney Injury Network (AKIN) criteria, the results revealed that: 12 (5.4%) had mild AKI; seven (3.1%) had moderate AKI; and five (2.2%) had severe AKI. A further 54 (24%) were diagnosed with dengue haemorrhagic fever (DHF); 11 (5%) were co-infected with leptospirosis; thrombocytopenia was present in 157 (70%); and 64 (29%) were hypotensive. Patients were divided into either group A (with AKI) or group B (without AKI), and group A was divided into mild (A1), moderate (A2) and severe (A3) subgroups. We recorded: a higher total white count (A = 9824; B = 6706; P = 0.01); serum glutamic pyruvic transaminase (SGPT; A = 450; B = 144; P = 0.001); alkaline phosphatase (ALP) levels (A = 207; B = 42; P = 0.001); lower albumin (A = 2.65; B = 3.09; P < 0.001); and serum bicarbonate (A = 20.57; B = 23.21; P = 0.009). Hypotension ( P = 0.01), coexisting viral hepatitis ( P < 0.001), sepsis ( P < 0.001), multiple organ dysfunction syndrome (MODS; P < 0.001) and the need for inotropes ( P < 0.001) were associated with DF. Total white count ( P = 0.038), glomerular filtration rate (GFR) on discharge ( P = 0.034), specific gravity of urine ( P = 0.006), ALP ( P = 0.013), SGPT ( P = 0.042), MODS ( P = 0.05) and use of platelet fresh frozen plasma (FFP; P = 0.007) were significantly different between mild, moderate and severe AKI subgroups. Twenty-two (9%) died. AKI is associated with an increased mortality in DF ( P = 0.005).

Only 3–5% of all patients with end-stage renal disease (ESRD) in India get some form of RRT from the existing pool of 900 nephrologists [2, 3]. As referral pattern varies widely in India for uremia therapy, there is no robust national database on the prevalence and incidence of dialysis therapy except for isolated reports. The cost of maintenance hemodialysis (MHD) for a single session varies from US $10 to 65 and most patients are maintained on twice-aweek dialysis. One-third of the 30 000 MHD patients are in the major metropolitan cities of Chennai, Delhi, Mumbai and Kolkata, whereas the majority of the Indian population lives in small towns and villages far away from cities. The hidden cost of travel to the hemodialysis (HD) center and loss of daily wages for the patient and the accompanying person is not usually calculated when the cost of HD is taken into consideration. The unmet needs of RRT must be covered by continuous ambulatory peritoneal dialysis (CAPD) that is available even in remote places in the country. There are ~7000 prevalent patients on chronic peritoneal dialysis in India. The cost is substantially less with PD, and the four industries which are involved in CAPD in India have network systems to deliver dialysis supplies to the residence without any additional cost. The use of erythropoietin (EPO) and iron is comparatively lower in CAPD patients compared to HD patients in India to the advantage of CAPD as a favorable RRT.

AIM To perform a systematic-review and meta-analysis to compare outcomes of ivabradine combined with beta-blocker to beta-blocker alone in heart failure with reduced ejection fraction (HFrEF). METHODS We searched PubMed, Cochrane, EMBASE, CINAHL and Web of Science for trials comparing ivabradine + beta-blocker to beta-blocker alone in HFrEF. We performed a systematic-review and meta-analysis of published literature. Primary end-point was combined end point of cardiac death and hospitalization for heart failure. RESULTS Six studies with 17671 patients were included. Mean follow-up was 8.7 ± 7.9 mo. Combined end-point of heart failure readmission and cardiovascular death was better in ivabradine + beta-blocker group compared to beta-blocker alone (RR: 0.93, 95%CI: 0.79-1.09, P = 0.354). Mean difference (MD) in heart rate was higher in the ivabradine + beta-blocker group (MD: 6.14, 95%CI: 3.80-8.48, P < 0.001). There was no difference in all cause mortality (RR: 0.98, 95%CI: 0.89-1.07, P = 0.609), cardiovascular mortality (RR: 0.99, 95%CI: 0.86-1.15, P = 0.908) or heart failure hospitalization (RR: 0.87, 95%CI: 0.68-1.11, P = 0.271). CONCLUSION From the available clinical trials, ivabradine + beta-blocker resulted in a significantly greater reduction in HR coupled with improvement in combined end-point of heart failure readmission and cardiovascular death but with no improvement in all cause or cardiovascular mortality. Given the limited evidence, further randomized controlled trials are essential before widespread clinical application of ivabradine + beta-blocker is advocated for HFrEF.

A 57-year-old woman with a creatinine of 0.8 mg/dL and a normal urine analysis, was investigated with technetium-99m renogram and multidetector computerized tomography (MDCT) as a renal donor for her daughter. The glomerular filtration rate (GFR) was 100 mL/min with the left kidney 42 mL/min and right kidney 58 mL/ min. MDCT revealed a large lipomatous tumour on the renal cortex of the left lower pole with exophytic extension into the perirenal space measuring 7.3 3 5.2 cm (Figure 1). The arterial phase revealed dual arterial supply to the left kidney with the tumour being supplied by a branch from the lower renal artery (Figure 2a). The presence of fat [67 Hounsfield unit (HU)] with interposed soft tissue (42 HU), ectatic vessels and an aneurysm that measured 9 mm 3 8.9 mm with no direct arteriovenous shunting favoured the diagnosis of angiomyolipoma. Superselective catheterization of the feeding artery was performed and the neovascular vessels were embolized. Post-embolization MDCT revealed complete obliteration of the abnormal feeding artery and the aneurysmal lumen (Figure 2b). A week later, the GFR was 107 mL/min, left kidney 43 mL/min and right kidney 64 mL/min. Angiomyolipoma is a benign renal neoplasm with variable amounts of fat, vascular and smooth muscle elements. Attenuation of less than 20 HU on computerized tomography is widely accepted to confirm the presence of fat and this finding confirms the diagnosis of angiomyolipoma [1]. A tumour >4 cm with an aneurysm measuring >5 mm has a high risk of rupture [2].

This is a retrospective analysis of 858 patients from 2 medical centers on maintenance hemodialysis from January 1998 - January 2010(Males–599, females 259) (364 diabetics [42.5%]) (Mean Age - 48.5+22.74, >60 - 76.5% and