Quality of life in Indian patients with functional dyspepsia: Translation and validation of the Hindi version of Short-Form Nepean Dyspepsia Index.

BACKGROUND/PURPOSE: Patients with functional dyspepsia (FD) have poor health-related quality of life (HRQOL), but Indian data are  lacking. Also, there is non-availability of validated disease-specific questionnaire to assess HRQOL in Hindi-speaking patients with dyspepsia. We aimed to develop and validate a reliable translation of Short-Form Nepean Dyspepsia Index (SF-NDI) in Hindi, and assess the impact of FD on HRQOL in Indian patients. METHODS: Cross-cultural adaptation of English version of SF-NDI, translation to Hindi, and adaptation of Hindi version were performed using standard procedures. English and Hindi versions were assessed against Short Form-36 (SF-36), examining for internal consistency, test-retest reliability, and validity. RESULTS: Total 211 FD patients (144 Hindi speaking, 67 English speaking) were enrolled (mean age 40.8 ± 11.7 years; male:female = 115:96). Median total SF-NDI scores for both languages were 38.75 and 40.0, respectively. Test-retest reliability intraclass correlation coefficients were 0.85 (Hindi) and 0.89 (English). Internal consistency evaluation revealed Cronbach's α coefficient of 0.79-0.86 (Hindi) and 0.78-0.89 (English). SF-NDI sub-scales showed moderate to good correlation with various domains of SF-36 (content validity). There was significant (p < 0.001) decline of HRQOL in patients with severe dyspepsia relative to those with mild dyspepsia (construct validity). On multivariate analysis, factors independently associated with HRQOL were duration of symptoms and dyspepsia severity. CONCLUSION: Both English and Hindi versions of SF-NDI are reliable and valid for HRQOL assessment in Indian FD patients, and will be useful in future epidemiological and clinical studies. Indian FD patients have poor HRQOL, being worse in those with severe dyspepsia and longer duration of symptoms.

Characterization of cardiac time intervals in healthy bonnet macaques (Macaca radiata) by using an electronic stethoscope.

Nonhuman primates are used frequently in cardiovascular research. Cardiac time intervals derived by phonocardiography have long been used to assess left ventricular function. Electronic stethoscopes are simple low-cost systems that display heart sound signals. We assessed the use of an electronic stethoscope to measure cardiac time intervals in 48 healthy bonnet macaques (age, 8±5 y) based on recorded heart sounds. Technically adequate recordings were obtained from all animals and required 1.5±1.3 min. The following cardiac time intervals were determined by simultaneously recording acoustic and single-lead electrocardiographic data: electromechanical activation time (QS1), electromechanical systole (QS2), the time interval between the first and second heart sounds (S1S2), and the time interval between the second and first sounds (S2S1). QS2 was correlated with heart rate, mean arterial pressure, diastolic blood pressure, and left ventricular ejection time determined by using echocardiography. S1S2 correlated with heart rate, mean arterial pressure, diastolic blood pressure, left ventricular ejection time, and age. S2S1 correlated with heart rate, mean arterial pressure, diastolic blood pressure, systolic blood pressure, and left ventricular ejection time. QS1 did not correlate with any anthropometric or echocardiographic parameter. The relation S1S2/S2S1 correlated with systolic blood pressure. On multivariate analyses, heart rate was the only independent predictor of QS2, S1S2, and S2S1. In conclusion, determination of cardiac time intervals is feasible and reproducible by using an electrical stethoscope in nonhuman primates. Heart rate is a major determinant of QS2, S1S2, and S2S1 but not QS1; regression equations for reference values for cardiac time intervals in bonnet macaques are provided.

The relation between blood pressure changes induced by passive leg raising and arterial stiffness.

Passive leg raising (PLR) elicits cardiorespiratory changes because of intra-thoracic blood pooling. We previously found PLR to lower blood pressure (BP) in healthy subjects. To determine the effects of cardiovascular (CV) risk factors on the PLR BP lowering response, we measured brachial artery, systolic (SBP), diastolic (DBP), and pulse pressure (PP) before and 1 minute after 60° PLR, in 125 subjects (58% males, age 48 ± 18 years) with/without CV risk factors/disease. Baseline carotid-radial pulse wave velocity (PWV) and augmentation index (AI) were measured by applanation tonometry. Changes (∆) in SBP and BA PP ranged from +31 to -27 and +35 to -20 mm Hg and were normally distributed. Mean BP decreases upon PLR were ΔSBP -3 ± 9 (P < .001), and ΔPP -2 ± 8 mm Hg (P = .04). On univariate analyses, ΔSBP was correlated with age (r = 0.31, P < .001), PWV (r = 0.53, P < .001), AI (r = 0.25, P < .01), hypertension (r = 0.37, P < .001), hypercholesterolemia (r = 0.25, P < .01) and renal insufficiency (r = 0.19, P = .038). ΔPP was correlated with age (r = 0.31, P < .001), PWV (r = 0.45, P < .001), AI (r = 0.23, P = .01), hypertension (r = 0.22, P = .01), hypercholesterolemia (r = 0.27, P < .001). Multivariate analysis showed PWV the only independent predictor of ΔSBP (B = 3.2, r(2) = 0.40, P < .001) and of ΔPP (B = 2.6, r(2) = 0.36, P < .001). Therefore, changes in SBP and PP induced by PLR are independently and inversely related to carotid-radial PWV.

Determinants of a blunted carotid-to-radial pulse wave velocity decline in response to hyperemia.

Carotid-radial pulse wave velocity (PWV) decreases in normal healthy individuals following hyperemia provoked by release of arterial cuff occlusion. To determine the effects of specific cardiovascular (CV) risk factors on the hyperemic PWV response, we measured PWV before and after brachial artery (BA) occlusion in 218 participants (66% males, age 56 +/- 19 years), with and without CV risk factors/disease. DeltaPWV ranged from -46% to +35% and values were normally distributed. On univariate analyses, DeltaPWV correlated with age, hypertension (Htn), hypercholesterolemia, diabetes mellitus (DM), coronary disease, congestive heart failure (CHF), smoking, and mean arterial pressure (MAP). On multivariate analysis, DeltaPWV was independently related to Htn (B = 4.56, P = .03) and CHF (B = 7.34, P = .008) and trended toward a higher MAP (B = .113, P = .067), DM (B = 4.01, P = .11), and hypercholesterolemia (B = 3.36, P = .12). In conclusion, hyperemic changes in carotid-radial PWV values are independently related to Htn and CHF and possibly DM and hyperlipidemia.