A 69-year-old woman with a recurrent skull-base meningioma developed recurrent hypothermia during rehabilitation, initially misattributed to infection. Episodes followed a circadian pattern and were associated with delirium, pancytopenia, and signs of central endocrine dysfunction. MRI showed a large meningioma compressing the hypothalamus with an intact corpus callosum. Infection and adrenal insufficiency were excluded. Hypothermia resolved with external warming, and pancytopenia normalized spontaneously. Subclinical hypothyroidism and central hypogonadism were noted, consistent with hypothalamic-pituitary axis involvement. These findings supported a diagnosis of acquired spontaneous periodic hypothermia (SPH) due to hypothalamic compression. This case illustrates that early recognition of SPH in patients with skull-base tumors can prevent misdiagnosis and guide appropriate supportive care and monitoring.
Background Inflammatory markers and dysregulation of certain cell subtypes play a crucial role in stroke severity and complications. This study aimed to determine the correlation of the lymphocyte-monocyte ratio (LMR) with stroke severity and outcome and establish its potential as a prognostic marker in stroke patients in the Indian population. Methods In this prospective observational study, 102 patients with ischemic and hemorrhagic strokes were included. LMR was calculated from the initial complete blood count analysis at admission. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score, and the 30-day functional outcome was classified according to the modified Rankin Scale (mRS). The correlation between LMR and NIHSS and mRS was determined using Pearson's correlation test, and the predictive value of LMR was established using ROC Results Most patients (75.5%) had ischemic stroke, and the relative risk of mortality in hemorrhagic stroke was 2.64, higher than in ischemic stroke. ROC curve analysis showed that a lower LMR value was an independent predictor of poor outcome (mRS > 3) in stroke patients at 30 days, with an area under the curve (AUC) of 0.844 (95% CI 0.766-0.922, P<0.001). An LMR cut-off of 2.34 was found to be 86.5% sensitive and 74% specific in predicting poor outcomes. Conclusion The lymphocyte-monocyte ratio at admission was strongly associated with stroke severity and functional outcome, with a significant moderate negative correlation and can be used a prognostic marker.
Background OCT improves PCI outcomes compared with angiography alone but requires contrast to displace blood for image acquisition. In patients at risk of contrast-induced nephropathy, minimizing contrast use is clinically important. Objectives The objective of the study was to compare heparinized saline and contrast as flushing media for coronary frequency domain optical coherence tomography (OCT) during percutaneous coronary intervention (PCI). Methods In this prospective, multicenter, observational study, paired contrast and heparinized saline OCT pullbacks were obtained during the same procedure from 166 patients undergoing PCI at 4 tertiary centers in India. A total of 2072 matched pairs of OCT frames (in 259 paired OCT runs) were analyzed by 2 blinded investigators. Vessel dimensions including proximal reference diameter, minimal lumen area, minimum lumen diameter, and distal reference diameter (DRD) were compared. Ethical approval was obtained at all participating institutions, and all patients provided informed consent. Results Saline and contrast-based OCT demonstrated no significant differences in proximal reference diameter (2.76 ± 0.59 vs 2.74 ± 0.60 mm; P = 0.65), minimal lumen area (5.33 ± 2.48 vs 5.36 ± 2.52 mm2; P = 0.85), minimum lumen diameter (2.55 ± 0.68 vs 2.56 ± 0.66 mm; P = 0.78), or distal reference diameter (2.54 ± 0.55 vs 2.55 ± 0.55 mm; P = 0.83). Bland-Altman analysis showed good agreement without proportional bias. Interobserver reliability for vessel measurements was moderate to good with Intraclass Correlation Coefficient ranging from 0.69 to 0.79. Sensitivity analysis for clustering confirmed the robustness without proportional bias. No adverse events were observed with saline flushes. Conclusions Heparinized saline provides vessel measurements comparable to contrast media for frequency domain OCT without safety concerns. Saline flushing is a feasible alternative for OCT-guided PCI, particularly in patients at risk of contrast-induced nephropathy.
Introduction: There are strong guidelines regarding the importance of SGLT-2 inhibitors (SGLT2i) in reducing mortality in patients with heart failure with reduced ejection (HFrEF). However, the role of SGLT2i in the management of patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with mildly reduced ejection fraction (HFmrEF) remains ambiguous. Methods: A systematic review and meta-analysis of SGLT2i randomized controlled trials (RCTs) in HFpEF and HFmrEF, with and without diabetes was conducted (Prospero ID - CRD42023464479). Databases including Clinicaltrials.gov, PubMed, Biomed Central, Scopus, and Science Direct were searched from 2018 to 2024. Hospitalization due to heart failure (HFH) with HFpEF and HFmrEF was the primary outcome analyzed, followed by a subgroup analysis of HFH in HFpEF only. Secondary outcomes analyzed included cardiovascular (CV) death, all-cause mortality, and serious adverse effects. Results: In seven RCTs involving 31,057 participants, meta-analysis using random effects models showed that SGLT2i treated patients had a statistically significant reduction in HFH risk (OR=0.74, p<0.00001) compared to placebo or standard of care (SOC). A subgroup analysis, in HFpEF only patients, also showed a statistically significant reduction (OR=0.72, p<0.0001) in HFH odds. Statistical analysis of secondary outcomes showed a statistically non-significant difference in CV death risk (OR=0.92, p=0.13), all-cause mortality (OR=0.94, p=0.13), and any serious adverse events (OR=0.92, p=0.10). Discussion: This meta-analysis demonstrates that SGLT2i significantly reduce the risk of heart failure hospitalization in patients with preserved and mildly reduced ejection fraction, regardless of diabetes status. While reductions in cardiovascular and all-cause mortality, as well as serious adverse events, were observed, these did not reach statistical significance. These findings align with emerging evidence suggesting a broader cardioprotective role for SGLT2i across the heart failure spectrum, although further studies are needed to clarify their mortality benefit and long-term safety in HFpEF and HFmrEF populations. Conclusion: This meta-analysis found a significant reduction in HFH with the use of SGLT2i in patients with HFpEF and HFmrEF. Secondarily, there was a statistically non-significant reduction in allcause mortality, CV death risk, and serious adverse events with the use of SGLT2i.
