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Purpose: Epidemiological studies have shown an association between coronary artery disease (CAD) and osteoporosis. We studied the prevalence of CAD among postmenopausal women with osteoporosis. Factors that were significantly associated with CAD were also assessed. Methods: This was a cross-sectional study conducted over a period of 2 years. Consecutive postmenopausal women aged ≥50 years were recruited. The details of an underlying CAD were obtained. Bone biochemical parameters, bone mineral density and body composition were assessed. Results: A total of 370 postmenopausal women with mean (standard deviation [SD]) ages of 61.6 (6.2) and 60.1 (6.0) years and a body mass index of 25.3 (14.1) kg/m 2 were recruited. Among them, 110 of 370 patients (29.7%) had an underlying CAD and 222 of 370 (60%) had osteoporosis at either the femoral neck or lumbar spine (LS). The odds of CAD among those with osteoporosis were 3.5 (95% confidence interval [CI]: 2.1-5.9). An LS T-score of ≤-2.2 had a sensitivity of 80% and a specificity of 45% in predicting CAD (area under the curve, AUC: 0.736; 95% CI: 0.677-0.795; p<0.001). A femoral neck T-score of ≤-1.9 had a sensitivity of 80% and a specificity of 60% in predicting CAD (AUC: 0.748; 95% CI: 0.696-0.800; p<0.001). On a logistic regression analysis after adjusting for various clinical parameters, femoral neck osteoporosis had the highest odds of CAD. Conclusion: The prevalence of CAD was higher among postmenopausal women with osteoporosis. Femoral neck osteoporosis conferred the highest odds of CAD after adjustment for other clinical factors., Competing Interests: Disclosures: Aditya John Binu, Abhishek Mittal, Kripa Elizabeth Cherian, Logesh M. Ravi, Mayank Agarwal, Anoop George Alex, Nitin Kapoor and Thomas V Paul have no financial or non-financial relationships or activities to declare in relation to this article., (© Touch Medical Media 2024.)

Sarcopenic obesity (SO) is a chronic condition and an emerging health challenge, in view of the growing elderly population and the obesity epidemic. Due to a lack of awareness among treating doctors and the non-specific nauture of the associated symptoms, SO remains grossly underdiagnosed. There is no consensus yet on a standard definition or diagnostic criteria for SO, which limits the estimation of the global prevalence of this condition. It has been linked to numerous metabolic derangements, cardiovascular disease (CVD) and mortality. The treatment of SO is multimodal and requires expertise across multiple specialties. While dietary modifications and exercise regimens have shown a potential therapeutic benefit, there is currently no proven pharmacological management for SO. However, numerous drugs and the role of bariatric surgery are still under trial, and have great scope for further research. This article covers the available literature regarding the definition, diagnostic criteria, and prevalence of SO, with available evidence linking it to CVD, metabolic disease and mortality, and an overview of current directives on management., Competing Interests: Disclosures: Aditya John Binu, Nitin Kapoor, Saptarshi Bhattacharya, Kamal Kishor and Sanjay Kalra have no financial or non-financial relationships or activities to declare in relation to this article., (© Touch Medical Media 2023.)

Background: Bacterial sepsis is associated with significant morbidity and mortality. However, to date, there is no single test that predicts sepsis with reproducible results. We proposed that using a combination of clinical and laboratory parameters and a novel biomarker, plasma neutrophil gelatinase-associated lipocalin (NGAL) may aid in early diagnosis., Method: A prospective cohort study was conducted at a tertiary care center in South India (June 2017 to April 2018) on patients with acute febrile episodes fulfilling the Systemic Inflammatory Response Syndrome (SIRS) criteria. Plasma NGAL and standard clinical and laboratory parameters were collected at the admission. Bacterial sepsis was diagnosed based on blood culture positivity or clinical diagnosis. Clinically relevant plasma NGAL cut-off values were identified using the receive operating characteristic (ROC) curve. Clinically relevant clinical parameters along with plasma NGAL's risk ratios estimated from the multivariable Poisson regression model were rounded and used as weights to create a new scoring tool., Results: Of 100 patients enrolled, 37 had bacterial sepsis. The optimal plasma NGAL cut-off value to predict sepsis was 570 ng/mL [area under the curve (AUC): 0.69]. The NGAL sepsis screening tool consists of the following clinical parameter: diabetes mellitus, the presence of rigors, quick sequential organ failure assessment (qSOFA) >2, a clear focus of infection, and the plasma NGAL >570 ng/mL. A score of <3 ruled out bacterial sepsis and a score >7 were highly suggestive of bacterial sepsis with an interval likelihood ratio (LR) of 7.77., Conclusion: The NGAL sepsis screening tool with a score >7 can be used in the emergency department (ED) to identify bacterial sepsis., How to Cite This Article: Paul A, Newbigging NS, Lenin A, Gowri M, Varghese JS, Nell AJ, et al. Role of Neutrophil Gelatinase-associated Lipocalin (NGAL) and Other Clinical Parameters as Predictors of Bacterial Sepsis in Patients Presenting to the Emergency Department with Fever. Indian J Crit Care Med 2023;27(3):176-182., Competing Interests: Source of support: Institutional post-graduation thesis fund. Conflict of interest: None, (Copyright © 2023; The Author(s).)

Background: Obesity is associated with increased all-cause mortality and cardiovascular disease (CVD). An electrocardiogram (ECG) may be used to screen for subtle signs of CVD or altered cardiac morphology in the obese. Methodology: This observational cross-sectional analysed ECG changes in patients with obesity at a tertiary care centre in southern India. Results: One hundred and fifty adult patients with a mean (SD) BMI of 39.9 (6.7) kg/m 2 were recruited in the study after excluding those with comorbidities (diabetes mellitus, systemic hypertension) or on chronic medications (ACE inhibitors). The cohort showed a female predominance (69.3%), with a mean (SD) age of 45.4 (11.2) years. Most patients exhibited a sinus rhythm (78%), with one patient showing features of first-degree conduction block. Sinus tachycardia was seen in 32 (21.3%) patients. We observed left and right ventricular hypertrophy in five (3.3%) and three (2%) patients, respectively. Observed ECG patterns included a prolonged QTc in 16 (10.7%) patients, inverted T-waves (mostly in the inferior leads) in 39 (26%) patients and ST-segment depression (predominantly in the lateral leads) in 14 (9.3%) patients. A greater prevalence was noted for morbid obesity. No deaths were reported in our cohort. Conclusions: The predominant ECG variations in this cohort included tachycardia, atrial enlargement, ventricular hypertrophy, conduction defects, LAD, features of ischemia or old infarction and repolarization abnormalities, with a greater prevalence in morbid obesity. Further studies are needed to assess the impact of weight reducing measures on reversibility of these changes and determine the association with outcomes in obese patients.

An important phase of radiation treatment planning is the accurate contouring of the organs at risk (OAR), which is necessary for the dose distribution calculation. The manual contouring approach currently used in clinical practice is tedious, time-consuming, and prone to inter and intra-observer variation. Therefore, a deep learning-based auto contouring tool can solve these issues by accurately delineating OARs on the computed tomography (CT) images. This paper proposes a two-stage deep learning-based segmentation model with an attention mechanism that automatically delineates OARs in thoracic CT images. After preprocessing the input CT volume, a 3D U-Net architecture will locate each organ to generate cropped images for the segmentation network. Next, two differently configured U-Net-based networks will perform the segmentation of large organs-left lung, right lung, heart, and small organs-esophagus and spinal cord, respectively. A post-processing step integrates all the individually-segmented organs to generate the final result. The suggested model outperformed the state-of-the-art approaches in terms of dice similarity coefficient (DSC) values for the lungs and the heart. It is worth mentioning that the proposed model achieved a dice score of 0.941, which is 1.1% higher than the best previous dice score, in the case of the heart, an important organ in the human body. Moreover, the clinical acceptance of the results is verified using dosimetric analysis. To delineate all five organs on a CT scan of size [Formula: see text], our model takes only 8.61 s. The proposed open-source automatic contouring tool can generate accurate contours in minimal time, consequently speeding up the treatment time and reducing the treatment cost., (© 2022. Australasian College of Physical Scientists and Engineers in Medicine.)

Peripartum cardiomyopathy is a syndrome of maternal heart failure with decreased left ventricular ejection fraction affecting maternal and fetal well-being. We analysed clinical profiles and outcomes in women with peripartum cardiomyopathy enrolled retrospectively from a tertiary care centre in southern India (1 January 2008-31 December 2014). The incidence of peripartum cardiomyopathy was one case per 1541 live births. Fifty-four women with a mean age of 25.5 years and mean gestational age of 35.4 weeks were recruited; 35 were primigravidae. Maternal and fetal deaths occurred in 9.3% and 24.1% of subjects, respectively. Mild-to-moderate maternal anaemia (80-110 g/L) was associated with fetal mortality (p = 0.02). Reduced left ventricular ejection fraction (<30%, p = 0.04) and cardiogenic shock (p = 0.01) were significantly associated with adverse maternal outcomes. Forty per cent of women were followed up after 24.2 ± 17.7 months, and in these women a significant increase in left ventricular ejection fraction was seen (mean 16.4%, p < 0.01); all were asymptomatic. Peripartum cardiomyopathy with poor left ventricular ejection fraction and shock is associated with adverse maternal outcomes, while non-severe maternal anaemia predisposes to adverse fetal outcomes. Significant left ventricular ejection fraction recovery occurred on follow-up., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)

Objective: Vitamin D deficiency is widely prevalent worldwide. This has led to a significant surge in referrals for vitamin D assessment in recent years. The cost-effectiveness and rationalization of this practice is uncertain. This study aimed to evaluate the referral pattern for vitamin D testing from a tertiary center in southern India., Materials and Methods: This was a cross-sectional study done over a period of one year (2017). A total of 95,750 individuals, referred for vitamin D screening were included in this study. Details regarding referring departments and indications for referral were obtained from the computerized hospital information processing system (CHIPS)., Results: The study population exhibited a female preponderance (54.1%) with mean (SD) age of 40.3 (18.5) years. Overall, 44% were found to have vitamin D deficiency. Most of the referrals were from nephrology (15.4%), neurology (10.1%), and orthopedics (9.1%). Nevertheless, dermatology, the staff-clinic, and hematology which contributed to 3.3%, 1.7%, and 1.7% of referrals, had a higher proportion of vitamin D deficiency of 59.1%, 57.7%, and 64.6%, respectively. Although the most common indications for referral were generalized body aches (20.5%) and degenerative bone disorders (20.1%), the proportion of subjects with vitamin D deficiency referred for these indications were 46.1% and 41.6%, respectively. In contrast, chronic steroid use that accounted for 3.3% of the referrals had 59.1% of subjects who were deficient in vitamin D., Conclusion: To ensure a rational approach to vitamin D testing, clinicians ought to use their discretion to screen those truly at risk for vitamin D deficiency on a case to case basis and avoid indiscriminate testing of the same., Competing Interests: None

A 65-year-old woman presented with a history of progressive dyspnoea, left pleuritic pain, loss of weight and appetite. Previous history was significant for pulmonary tuberculosis diagnosed 10 years before. Physical examination revealed a left supraclavicular soft tissue mass with absent breath sounds over the left hemithorax. Investigations revealed hypercalcemia with albumin:globulin reversal. The bone marrow biopsy was consistent with the diagnosis of multiple myeloma (IgG). Pleural fluid analysis revealed an exudative effusion; cytology showed mature plasma cells and plasmablasts. Serum electrophoresis revealed an M band in the gamma region. Biopsy of the supraclavicular mass revealed plasma cells which were CD 138+ with Kappa light chain restriction. She was initiated on chemotherapy and is currently doing well. Myelomatous pleural effusion is a rare presentation of multiple myeloma., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The incidence of postmenopausal osteoporosis continues to rise, as population ages. The morbidity and mortality associated with osteoporotic fractures have a significant negative impact on the economy and quality of life of the affected individual and the community, at large., Objectives: We aimed to study the prevalence of osteoporosis in ambulant rural postmenopausal women, and to look at their dietary calcium intake (DCI) and Vitamin D status., Subjects and Methods: This was a cross-sectional study conducted in 1565 ambulant South Indian rural postmenopausal women. Bone mineral density was estimated by a dual-energy X-ray absorptiometry scan at the femoral neck (FN) and lumbar spine (LS). DCI was calculated by recall for the previous week, and the blood bone biochemical profile was measured., Results: The mean standard deviation (SD) age and body mass index of this population were 60.7 (7.2) years and 26.2 (4.8) kg/m 2 , respectively. The prevalence of osteoporosis was 22% at the FN and 39% at the LS. An increase in the prevalence of osteoporosis was noted at both sites, in successive age categories. Mean (SD) DCI was 420 (282) mg/24 h. Fifty-four percent had Vitamin D deficiency (VDD) (<20 ng/ml) and 6% had severe VDD (<10 ng/ml)., Conclusion: A significant proportion of this large cohort of south Indian healthy rural postmenopausal women had osteoporosis at either site with advancing age. Most of them had a suboptimal DCI, and over half of them had VDD., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Indian Journal of Community Medicine.)

Referral patterns for bone mineral density testing by dual energy X-ray absorptiometry (DXA) scanning are seldom studied. In our study, the overall proportion of referrals from specialties remained low. This highlights the need for adequate utilisation of DXA by specialties treating subjects at risk for osteoporosis., Purpose/objectives: The knowledge of referral patterns for DXA scanning (dual energy X-ray absorptiometry) for bone mineral density (BMD) measurement is relevant in a developing country like India. We studied the referral source and clinical and densitometric profile of patients referred for DXA scanning at a south Indian tertiary care centre., Methods: We conducted a cross-sectional study over 3 months and included subjects referred during this period for BMD assessment (lumbar spine and femoral neck) by DXA scan. Details regarding referring departments and reasons for referral were collected. The number of patients seen in individual departments was obtained during the study period and respective proportions of patients referred were calculated., Results: Of the 1932 subjects included in the study, we observed a definite female preponderance (90.2%), with a mean (SD) age of 51.6 (13.3) years. The greatest number of referrals came from the departments of rheumatology (37%; n = 724) and endocrinology (20%; n = 382). Overall, 36% were referred for inflammatory arthritis or systemic inflammatory disorders (n = 696) and 34% for postmenopausal state screening (n = 657). In relation to the individual outpatient strength, the departments who referred the highest proportion of their patients were rheumatology (6.8%), endocrinology (1.76%) and geriatrics (1.05%). A diagnosis of osteoporosis at any one site was made in 41% (448 of 1107) and the BMD was below the expected range for age in 37% (304 of 825) of the referrals., Conclusion: Most referrals for DXA scanning were from rheumatology. Among the referred patients, about two fifth had osteoporosis and over one third had BMD below expected range for age. Although referrals by rheumatology were relatively higher, overall referrals from all departments remained low. This underscores the need for adequate utilisation of DXA by specialties treating subjects at risk for osteoporosis.

Endocrine disorders manifest as a disturbance in the milieu of multiple organ systems. The cardiovascular system may be directly affected or alter its function to maintain the state of homeostasis. In this article, we aim to review the pathophysiology, diagnosis, clinical features and management of cardiac manifestations of various endocrine disorders., Competing Interests: There are no conflicts of interest.