Preexisting renal failure diminishes the excretion of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), therefore limits the diagnostic value of this peptide for concomitant heart failure. The aim of this study was to evaluate the association between NT-proBNP and the stages of renal dysfunction in a typical population attended to emergency department with acute dyspnea.In this cross-sectional study, all consecutive patients with acute dyspnea underwent clinical evaluation, laboratory assessment of NT-proBNP, and echocardiographic examinations. Among subjects, 54.5% were diagnosed as heart failure. Grouping variables according to renal function capacity and ejection fraction, independent variables were compared with Kruskal-Wallis or ANOVA with posthoc tests. Correlation and linear regression analysis were done to analyze the variables associated with NT-proBNP. The diagnostic performance of NT-proBNP was evaluated by receiver-operating characteristic (ROC) curve.Serum median NT-proBNP level in patients with severe renal impairment was significantly higher than moderate and mildly decreased renal functions (p=0.001). In patients with moderate and severe left ventricular failure, NT-proBNP was significantly higher compared with normal subjects (LVEF>50%) (p=0.040, and 0.017, respectively). Renal dysfunction was associated in 56% of patients with heart failure. The area under the ROC curve of NT-proBNP for identifying left ventricular failure in patients with renal failure (eGFR<90 mL/min/1.73 m2) was 0.649 and reached significant difference (95% CI:0.548-0.749, p=0.005).In addition to NT-proBNP measurement in clinical judgement of heart failure, renal functions have to be taken into consideration to avoid misdiagnosis.
Inferior shoulder dislocation, also referred to as luxatio erecta, is a rare type of shoulder dislocation. Its incidence is about 1 in 200 (0.5%) among all shoulder dislocations. The objective of this study was to review six cases of inferior shoulder dislocation, including their clinical and radiological presentation, management, and final outcome.Four males and two females, a total of six patients, with the diagnosis of inferior shoulder dislocation were treated between 2007 and 2010. Our purpose is to present our experience in the treatment of these patients together with the parallel research available in the literature.Constant score was used to evaluate shoulder function. Pain, position, daily activities, range of motion, and strength scores were noted. All patients had good to excellent results with full functional recovery within two years after closed reduction and shoulder rehabilitation.Doctors should be familiar with the occurrence of this infrequent condition and should prevent possible complications that might result from early reductions by using correct maneuvers in lieu of ordinary reduction techniques.
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