Introduction: Serum uric acid levels are increased in CHF mostly by increased generation and partly by reduced excretion or both. Elevated uric acid levels indicate cardiac dysfunction and progression of heart failure through oxidative stress and free radical injury by increased xanthine oxidase activity. Epidemiological studies have shown that increased uric acid levels serve as a valid prognostic marker in congestive heart failure and indicate metabolic, functional and hemodynamic derangements. The purpose of this study is to determine the association between uric acid levels and heart failure and to find its significance in predicting mortality and severity of the disease as a prognostic risk marker. Methodology: The study was conducted in Coimbatore medical college hospital, Coimbatore, which included 100 patients who were admitted with features of heart failure. Patients, who satisfied the criteria for inclusion, were subjected to basic blood investigations and serum uric acid levels were measured in them. Echocardiography was done in all the patients to assess the severity of heart failure. The patients were followed up for a period of one month to determine the mortality and adverse outcomes. The patients were followed up for a period of one month to determine the mortality and adverse outcomes. Results: Hyperuricemia was found to be significantly higher in patients with cardiac failure and the severity of UA rise had a high correlation to the severity of heart failure. Hyperuricemia is more common in acute decompensated heart failure than chronic heart failure patients. Elevated serum uric acid levels correlate inversely with ejection fraction suggesting that progressive hyperuricemia in cardiac failure indicates deteriorating cardiac function. Patients with elevated serum UA levels were associated with poorer NYHA functional class proving that hyperuricemia predicts the severity of cardiac failure. Hyperuricemia patients were associated with adverse clinical and biochemical features compared to normouricemic patients in the form of increased QRS duration and inotropic requirements. Serum uric acid levels were increased in diabetes and hypertension and had an independent association, irrespective of the etiology of heart failure. Patients with higher uric acid levels were associated with adverse outcomes and poor prognosis in the form of increased rehospitalization rates and 30 day mortality rates. Conclusion: Thus, it is evident from this study that high serum uric acid levels could be a strong and valid biomarker of impaired prognosis and mortality in patients with cardiac failure, predicting the severity and hemodynamic derangements. The measurement of serum uric acid levels is simple and widely available at low cost. Hence routine measurement of serum uric acid levels in assessing the cardiovascular risks may contribute to the improved ability to stratify risk in cardiac failure.

Setting: Gulf Province, a rural area of mainland Papua New Guinea, is known to have one of the highest burdens of tuberculosis (TB) in the country. Objectives: To describe the characteristics and outcomes of TB patients registered for first-line treatment in Kerema General Hospital in Gulf Province between January and December 2016. Design: This was a retrospective cohort study using routinely collected programme data. Results: Of 347 cases with a recorded TB site, 54% were male and 32% were aged 15 years. No human immunodeficiency virus (HIV) status was recorded for 51% of cases. TB was bacteriologically confirmed in 23% of cases. Among the cohort, there were 145 extrapulmonary TB cases (42%); the site of disease was unknown in 56% of these cases. Of the 297 cases with treatment outcome evaluated, 56% had a favourable outcome and 26% were lost to follow-up. On multivariable analysis, extrapulmonary TB (adjusted OR [aOR] 0.51, 95%CI 0.30-0.88, P = 0.02) and bacteriologically confirmed TB (aOR 0.40, 95%CI 0.21-0.77, P  0.01) were associated with decreased odds of an unfavourable treatment outcome. Conclusion: The study findings highlight the need to improve TB diagnosis, access to HIV testing, treatment adherence, patient support and the quality of TB programme data in Gulf Province.

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