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Silenced by heart – Ortner’s syndrome (cardio-vocal hoarseness) – An unusual manifestation of a distant dreadful disease: A cross-sectional observational study

ABSTRACT Aims and Objectives: This study aims to explore the pathogenesis of hoarseness of voice resulting from cardiovascular disorders that affect the left recurrent laryngeal nerve (LRLN), supported by a review of the existing literature. Materials and Methods: This is a cross-sectional observational study conducted over a 3-year period, spanning from May 2019 to May 2022. The study involved the evaluation of 720 cases of hoarseness of voice through video-laryngoscopy. Within this cohort, we scrutinized eight distinct cases of Ortner’s syndrome, each attributed to various underlying causes. All patients with LRLN paralysis underwent a comprehensive clinical assessment, which encompassed chest X-rays, echocardiography, and chest computed tomography scans. Results: Out of the eight Ortner’s syndrome cases, six were associated with dilated pulmonary arteries, stemming from various etiologies such as rheumatic heart disease, mitral valve prolapse, pulmonary embolism, interstitial lung disease, portopulmonary hypertension, and patent ductus arteriosus. One case presented with pericardial effusion and pulmonary hypertension, while another case featured a dilated aorta secondary to severe aortic regurgitation. Among these cases, three patients underwent valve replacement, one underwent pericardiocentesis, and the remaining cases were managed conservatively. Only one case that underwent mitral valve replacement showed partial improvement in voice, while there was no significant improvement in the other cases. All cases remained under follow-up. Conclusion: Although cardiovascular-related hoarseness is an unusual presentation, it should be kept in mind for all cases of altered voice with underlying cardiac disease. Indirect laryngoscopy should be routinely performed in all cases of cardiac illness having hoarseness of voice.

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Exploring dyslipidemia and cardiovascular morbidity in chronic kidney disease patients: A cross-sectional study

ABSTRACT Introduction: Chronic kidney disease (CKD) is a prevalent health concern with significant implications for patient health. This study investigates the relationship between dyslipidemia and cardiovascular morbidity in CKD patients. CKD is characterized by kidney damage, reduced glomerular filtration rate, and is associated with various complications, including cardiovascular disease. Dyslipidemia, characterized by abnormal lipid levels, is common in CKD patients and contributes to the development of atherosclerosis and cardiovascular complications. Materials and Methods: This 1-year cross-sectional observational study was conducted at a tertiary care center in northern India. The study included 160 patients aged 16 and above who had been diagnosed with CKD. Researchers conducted a comprehensive analysis of lipid profiles in these patients and assessed cardiovascular morbidity through a review of clinical records. Results: In our study, we observed that 96 out of 160 patients diagnosed with CKD exhibited lower than recommended levels of high-density lipoprotein (HDL). Furthermore, in patients with CKD Stages IV and V, low-density lipoprotein (LDL) cholesterol (LDL-C) levels were notably elevated. Triglyceride levels (TGs) were consistently elevated across the board in our study. Specifically, the mean TGLs were 159, 162.8, 211, and 246.8 in CKD Stages II, III, IV, and V, respectively, which was statistically significant. In addition, total cholesterol levels were found to be elevated in 110 out of 160 patients within our study group. Most of the patients with CKD were found to have systolic or diastolic dysfunction on two-dimensional echocardiography. Furthermore, associated coronary artery disease was higher in Grade III and Grade V CKD patients. The study yielded several notable findings regarding cardiovascular morbidity in CKD patients. Cardiovascular morbidity was observed in a significant proportion of CKD patients, highlighting the strong link between CKD and heart-related complications. Abnormal lipid profiles, such as low levels of HDL and elevated levels of LDL-C, were prevalent in CKD patients with cardiovascular morbidity. An association between the severity of CKD, as determined by Stage, and the presence of cardiovascular morbidity was evident. Patients with advanced CKD Stages (IV and V) were more likely to exhibit cardiovascular complications. Dyslipidemia, particularly elevated TGLs, was implicated as a potential contributor to cardiovascular morbidity in CKD patients. Conclusion: This study underscores the significance of cardiovascular morbidity in CKD patients and its association with dyslipidemia. Findings suggest that early diagnosis and management of dyslipidemia are essential for mitigating the long-term cardiovascular consequences in CKD patients. Health-care providers should be vigilant in monitoring lipid profiles in CKD patients and implementing appropriate interventions to reduce their risk of cardiovascular complications. By integrating the study’s findings on cardiovascular morbidity with dyslipidemia in CKD patients, health-care practitioners can better understand the multifaceted nature of this condition and tailor their treatment strategies accordingly.

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A study of mortality frequency and clinical course of postoperative renal and abdominal visceral complications following open aortic surgery for abdominal aortic aneurysm requiring supra renal aortic cross-clamp

ABSTRACT Background: Endovascular interventions for abdominal aortic aneurysms (AAAs) are fast evolving; however, due to higher rates of reintervention and no survival benefits after 2 years, open surgical procedures are pivotal. Here, we present mortality and morbidity analysis of open surgical procedures requiring suprarenal cross clamping for AAA repair. Materials and Methods: The present study is a retrospective hospital record-based study selecting 34 cases that required suprarenal cross-clamping out of 200 abdominal aortic aneurysm surgeries. Out of the total 34 patients, 22 (64.7%) were males and 12 (35.3%) were females. The mean age of all participants was 58.05 years (with an 8.1 standard deviation). Out of 34 cases, 20 cases (58.8%) were classified as suprarenal and pararenal aneurysms and 14 cases were juxtarenal aneurysms (41.2%). Out of the 14 juxtrarenal aneurysm cases, 7 (50%) were atherosclerotic and 2 (14.3%) were Marfan’s Syndrome, while inflammatory were 2 (14.3%) and infected were 2 (14.3%) and 1 was a case of Takayasu’s arteritis (7.1%). Mortality and morbidity, including renal function decline, need for hemodialysis, acute pancreatitis, and hepatic and gastrointestinal (GI) complications, were recorded as early (up to 30 days) and late (up to 1 year). The results were recorded separately for suprarenal, pararenal, and juxtarenal aneurysm types and presented in that way, which is the highlight of our study. Results: Early mortality occurred in 3/34 (8.8%) cases, where late mortality happened in 2/34 (5.9%) cases, which are exclusive of early mortality cases. Considering the early mortality and complications, 2 out of 4 cases (50.0%) of the suprarenal group died early, renal dysfunction happened in 4/34 cases (11.8%), of which 3 (8.8%) required dialysis. No cases of pancreatitis, while acute liver failure complicated 3 out of 34 (8.8%) cases. GI bleed and mesentric ischemia each complicated 2 out of 34 cases (5.9%). Prolonged ileus was noticed as the most common GI complication complication. Early mortality was highest in the suprarenal group with renal dysfunction. Considering late mortality and complications, 1 out of 16 cases (6.3%) of the pararenal group died late, and 1 out of 14 cases (7.1%) of the juxta renal cases died late. There was no late mortality in the suprarenal group. Renal dysfunction happened in 2/34 cases (5.9%), of which none required dialysis. Complete data have been presented as per the aneurysm type. Conclusions: Patients requiring suprarenal aortic cross-clamping for open surgical repair of abdominal aorta aneurysm are usually high-risk surgical candidates, considering both early and late mortality and morbidity. Early mortality was maximum in the suprarenal group (50.0%), as were postoperative renal dysfunction and hemodialysis requirements. Visceral complications (acute liver failure and GI complications) were also maximum with the suprarenal group. Late mortality was recorded in the pararenal and juxtarenal groups, with renal dysfunction being recorded in the suprarenal and juxtarenal groups. Visceral complications were recorded in both pararenal and juxtarenal groups. One confounding factor could be the high early mortality in the suprarenal group, resulting in less number of survivors for late postoperative recording. Overall, we conclude that suprarenal aortic aneurysms carry the highest burden of early mortality with renal and visceral complications postoperative.

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Clinical profile and relevance of asymptomatic electrocardiography changes in lowlanders in high-altitude area

ABSTRACT Aim: The aim of this study was to study the significance of electrocardiography (ECG) changes in healthy lowlanders during ascent to high altitude (HA) and analyze the changes along with cardiac risk scores. Materials and Methods: An observational study was carried out in a tertiary center of North-East India over 9 months among individuals who were evacuated due to ECG abnormalities on ascent to higher altitudes. All subjects underwent a standardized cardiac evaluation to assess the significance of the changes. Results: Forty-six male subjects who were evacuated from HA were included and evaluated for cardiac disease in a phased manner. The subjects (n = 21), whose ECG reverted to normal on descent, had a normal cardiac evaluation. However, in subjects with persistent changes after descent (n = 25), four (16%) had an abnormal treadmill test, one (4%) had an abnormal echocardiography, and one (4%) had significant disease on angiography. Conclusions: ECG changes are common in individuals ascending to HA. While some ECG changes may be sinister and mandate investigations, most spontaneously revert to normal on descent and may not indicate clinically significant situations. It is important to note that risk scores are crucial for assessing the risk of heart disease. Analyzing ECG changes along with risk profiles may be useful in the interpretation of the ECG.

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Prevalence and prognostic significance of iron deficiency anemia among heart failure patients: A prospective observational study

ABSTRACT Background: Patients with chronic heart failure (CHF) frequently have associated iron deficiency, which may or may not be associated with anemia. Studies to ascertain the impact of repleting iron in patients with CHF and various other prognostic markers are lacking in Indian patients and the Indian context. Objectives: The objective is to study the prevalence of iron deficiency anemia in patients with CHF and its prognostic significance in predicting major adverse cardiovascular events (MACEs) during 6 months of follow-up along with the role of other clinical and demographic variables. Methodology: A prospective, observational, hospital-based study conducted in a government tertiary medical center in south India on patients admitted with the diagnosis of CHF. Full demographic and clinical characterization and all relevant laboratory investigations including iron profile were done per protocol. The incidence of a MACE (rehospitalization for heart failure or death) and its association with iron deficiency was studied at the end of a 6-month follow-up. Results: A total of 388 patients were followed for 6 months. Out of those, 211 patients (54%) developed composite outcomes. Old age, coronary artery disease, atrial fibrillation, previous heart failure history, chronic kidney disease, and reduced left ventricular ejection fraction were independent predictors of composite outcome. The prevalence of anemia in the study population was 71%, and iron deficiency was 63% (20% absolute and 43% relative). Iron deficiency without anemia was also an independent predictor of the composite outcome. Conclusions: This study highlights the underestimated and neglected burden of iron deficiency in CHF patients in India. It also suggests further large-scale studies to characterize this easily treatable condition better and consider routine testing of iron profiles in future Indian guidelines.

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Endothelial dysfunction in obesity

ABSTRACT Obesity is a condition caused by excess fat buildup, often measured using the body mass index (BMI) and categorized into underweight, normal weight, and obesity. Obesity is a global epidemic with an alarmingly rising incidence. Obesity is closely associated with insulin resistance, metabolic disorders, hypertension, and atherosclerosis, as well as endothelial dysfunction, which leads to numerous diseases. Noncommunicable diseases are significantly associated with high BMI and can have a negative impact on physical and psychological conditions. Endothelium, the internal lining of blood vessels, controls vascular tone, inflammation, and clotting processes. Endothelial dysfunction is a clinical complication characterized by the loss of normal endothelial cell homeostatic mechanisms. Reduced bioavailability of nitric oxide can be moderately related to endothelial dysfunction, which promotes vascular abruptions such as thrombosis, inflammation, plaque rupture, and other related conditions. The rise in obesity incidence and its global status highlights the urgent need to address responsible factors such as sedentary lifestyles, bad food habits, and globalization. Factors such as dietary modifications, low-cost food and beverages, and liberalization of international trade contribute to obesity, whereas factors such as genetics, poor diet, and lack of physical activity can also contribute to obesity.

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