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Objective The global prevalence of obesity is increasing and has nearly doubled in the last decade, disproportionately impacting less-developed countries. The aim of this cross-sectional study was to analyse health-related quality of life (HRQOL) in morbidly obese women attending a bariatric clinic in India, and assess potential obesity indicators that can be utilised in under-resourced settings, to better understand HRQOL of individual patients. Methods Anthropometric measurements were collected, including waist circumference, hip circumference, waist-hip ratio, waist-height ratio and body mass index (BMI). HRQOL was assessed using an obesity-related quality-of-life questionnaire focused on the impact of obesity on physical distress, self-esteem, sexual life and work life. Results The average BMI of study participants was 39.6 kg/m2, with an average HRQOL of 40.2%. The strongest correlation was noted between BMI and HRQOL (R2=0.16). Exploratory analyses demonstrated that patients with higher BMI quartiles had lower scores for physical impact and psychosocial impact, and higher scores for sexual health, comfort with food, and experience with dieting compared to patients in lower quartiles. Conclusion In South Indian, middle-aged, morbidly obese women, HRQOL is lower than average and is highly correlated with BMI, with different BMI levels having higher impacts in different subcategories, supporting the need for an individualised therapeutic focus for each patient.

Background: Obesity is sweeping across continents and is a major public health concern of the modern society. Aims: The main objective of this study was to study the demographic, anthropometric and dietary patterns of the morbidly obese and study region wise variation in their nutrient intake. Materials and Methods: The study was conducted on 101 morbidly obese individuals from different regions of India who attended the Bariatric clinic of a tertiary care hospital in India. Their socio-demographic details, anthropometric measurements were collected. The dietary assessment was done using a 24 hour dietary recall and a food frequency questionnaire. The study was approved by the Institutional review board and informed consent was obtained from them. Results: More than 3/4th of the patients were females and 61 per cent had Type 2 diabetes mellitus. The mean age of the male and female population was 41.3 + 15.5 years and 36.7 + 11.9 years respectively. Their mean BMI was 41kg/m2. The mean daily intake of calories was more than 2200kcal/day with a gross deficit in the intake of micronutrients. Bonferroni Test showed that there was region wise variation in dietary intake, South Indian female population had the lowest intake of the micronutrients and those from East India had the highest intake. In the male population, there was a significant regional difference in intake of Proteins (p=0.039) and Energy (p=0.024). Independent Sample T test showed that South Indian had the highest intake of Energy and proteins. Anthropometric measures showed positive relation with various macronutrient intakes. Conclusion: The obese patients require intense counselling by a dedicated team of an endocrinologist, psychiatrist, dietician, bariatric surgeon and a social worker to make achievable changes in the quality of life of the morbidly obese patients. Regional influences must be considered when counselling the patient.

Background It is uncertain whether there is an association between left ventricular (LV) ejection fraction ( LVEF ) or LV wall motion abnormality and embolic stroke of undetermined source ( ESUS ). Methods and Results We performed a retrospective, cross‐sectional study of patients with acute ischemic stroke enrolled in the CAESAR (Cornell Acute Stroke Academic Registry) from 2011 to 2016. We restricted this study to patients with ESUS and, as controls, those with small‐ and large‐artery ischemic strokes. LVEF had to be above 35% to be considered ESUS . In a secondary analysis, we excluded patients with ESUS who had any evidence of ipsilateral carotid atherosclerosis. Multiple logistic regression was used to evaluate whether LVEF or LV wall motion abnormality was associated with ESUS . We performed a confirmatory study at another tertiary‐care center. We identified 885 patients with ESUS (n=503) or small‐ or large‐artery strokes (n=382). Among the entire cohort, LVEF was not associated with ESUS (odds ratio per 5% decrement in LVEF , 1.0; 95% CI, 1.0–1.1) and LV wall motion abnormality was not associated with ESUS (odds ratio, 0.9; 95% CI, 0.5–1.6). The results were identical in our confirmatory study. In our secondary analysis excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, there was an association between LVEF and ESUS (odds ratio per 5% decrement in LVEF , 1.2; 95% CI, 1.0–1.5; P =0.04). Conclusions Among the entire cohort, no association existed between LVEF or LV wall motion abnormality and ESUS ; however, after excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, lower LVEF appeared to be associated with ESUS .

Introduction: Severely reduced left ventricular (LV) ejection fraction (EF) is an established risk factor for ischemic stroke. It is uncertain whether a modest reduction in LVEF (between 35%-50%) or the presence of LV wall motion abnormality may be a potential explanation for some embolic strokes of undetermined source (ESUS). Methods: We performed a retrospective cross-sectional study of patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 through 2016. For this analysis, we restricted the study cohort to patients with ESUS and, as controls, those with small- and large-artery ischemic strokes who received an echocardiogram within 14 days of stroke. A single investigator blinded to stroke subtype recorded LVEF and the presence of LV wall motion abnormalities from reports of echocardiograms performed for routine evaluation of stroke. These variables are uniformly reported in echocardiogram reports at our institution. Multiple logistic regression models adjusted for demographics and stroke risk factors were used to evaluate whether LVEF or LV wall motion abnormality was associated with ESUS. Results: We identified 885 patients with ESUS or small- or large-artery strokes. The mean LVEF was 62.4% (+/- 7.9%). There was no difference in LVEF in patients with ESUS (62.4%; 95% CI, 61.8-63.1%) as compared to patients with small- or large-artery strokes (62.3%; 95% CI, 61.4-63.2%; P =0.8). After adjustment for demographics and stroke risk factors, LVEF was not associated with ESUS (OR per 10% incremental increase in LVEF, 0.9; 95% CI, 0.8-1.0; P = 0.4). LV wall motion abnormality was present in 5.9% of patients, and in multivariable analysis, its presence was not associated with ESUS (OR 0.9; 95% CI, 0.5-1.6; P = 0.7). Conclusions: We found that neither a modest reduction in LVEF nor the presence of LV wall motion abnormality was associated with ESUS.

Introduction: Elevations in cardiac troponin in the absence of a clinically recognized acute myocardial infarction are typically seen in patients with acute ischemic stroke, though their significance remains unclear. Visceral infarcts appear to be more common in patients with embolic stroke subtypes, but their relation to troponin elevation remains uncertain. Methods: Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 through 2016, we included those with troponin measured within 24 hours from stroke onset and a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. A troponin elevation was defined as a value exceeding our laboratory’s upper limit of normal (0.04 ng/mL) in the absence of a clinically recognized acute ST-segment elevation myocardial infarction. Visceral infarction was defined as a renal or splenic infarction as ascertained by a single radiologist blinded to patients’ other characteristics including troponin levels. Multiple logistic regression was used to evaluate the association between elevated troponin and visceral infarction after adjustment for demographics and comorbidities. Results: Among 2,116 patients registered in CAESAR from 2011-2016, 153 patients had a troponin assay and underwent a contrast-enhanced abdominal computed tomographic scan, of whom 33 (21%) had an elevated troponin and 22 (14%) had a visceral infarct. The prevalence of visceral infarction was higher among patients with an elevated troponin (30%; 95% CI, 16-49%) than among patients without an elevated troponin (10%; 95% CI, 5-17%) ( P = 0.003). After adjustment for demographics and comorbidities, we found a significant association between elevated troponin and visceral infarct (OR, 3.8; 95% CI, 1.2-11.7). Conclusions: Among patients with acute ischemic stroke, elevated troponin in the absence of a clinically recognized acute ST-segment elevation myocardial infarction was associated with visceral infarction, which is typically caused by embolism. Our results support the hypothesis that post-stroke troponin elevation indicates the presence of underlying embolic sources.

Background Visceral infarctions appear to be more common in patients with embolic stroke subtypes, but their relation to troponin elevation remains uncertain. Methods Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 to 2016, we included those with troponin measured within 24 hours from stroke onset and a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. A troponin elevation was defined as a value exceeding our laboratory's upper limit of normal (.04 ng/ mL) in the absence of a clinically recognized acute ST-segment elevation myocardial infarction. Visceral infarction was defined as a renal or splenic infarction as ascertained by a single radiologist blinded to patients’ other characteristics. Multivariable logistic regression was used to evaluate the association between elevated troponin and visceral infarction. Results Among 2116 patients registered in CAESAR from 2011 to 2016, 153 patients had both a troponin assay and a contrast-enhanced abdominal computed tomographic scan, of whom 33 (21%) had an elevated troponin and 22 (14%) had a visceral infarction. The prevalence of visceral infarction was higher among patients with an elevated troponin (30%; 95% confidence interval [CI], 16%-49%) than among patients without an elevated troponin (10%; 95% CI, 5%-17%) (P = .003). After adjustment for demographics and comorbidities, we found a significant association between elevated troponin and visceral infarction (odds ratio, 3.9; 95% CI, 1.5-10.4). Conclusions Among patients with acute ischemic stroke, elevated troponin was associated with visceral infarction. Our results demonstrate that poststroke troponin elevation may indicate the presence of underlying embolic sources.