C-reactive protein as a predictor of adverse outcome in patients with acute coronary syndrome

The acute-phase reactant C-reactive protein [CRP] has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events. The objective of this study was to evaluate the prognostic value of CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. This prospective, single-centered study was carried out by the Department of Pathology in collaboration with the Department of Cardiology, Bolan Medical College Complex Quetta, Balochistan, Pakistan from January 2009 to December 2009. We studied 963 consecutive patients presenting with chest pain to Accident and Emergency Department. Patients were divided into four groups. Group-1 comprised patients with unstable angina; group-2 included patients with acute ST elevation myocardial infarction [STEMI]; group-3 comprised patients with Non-ST elevation myocardial infarction [Non-STEMI] and group-4 was the control group. All four groups were followed-up for 90 days for occurrence of cardiovascular events. The CRP was elevated [>3 mg/L] among 27.6% patients in Group-1; 70.9% in group- 2; 77.9% in group-3 and 5.3% in the control group. Among cases with elevated CRP, 92.1% had a cardiac event compared to 34.3% among patients with CRP œ3 mg/L [P < 0.0001]. The mortality was significantly higher [P < 0.0001] in group-2 [8.9%] and group-3 [11.9%] as compared to group-1 [2.1%]. There was no cardiac event or mortality in Group-4. Elevated CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications

Ribavirin: an effective treatment of Crimean-Congo haemorrhagic fever

To determine the efficacy of Ribavirin, an anti-viral drug, in patients diagnosed to have CCHF. Design: A hospital-based prospective study. Place and Duration: The Department of pathology in collaboration with the Department of Medicine, Sandeman Provincial Teaching Hospital, Quetta, Balochistan, conducted this study from March 1st, 1998 to December 31st, 1999. Patients and A total of 94 cases were included in the study on high index of suspicion of CCHF. The major criteria of admission were a short history of high-grade fever associated with bleeding from more than one site, i.e., haematemesis, epistaxis etc. the mean age was 34.71+12.81 years. All the suspected cases were kept in isolation unit of the hospital and barrier nursing was advised. All the 94 cases were sent to CDC, Atlanta, USA for confirmation and 39 [41.4%] were confirmed to have CCHF. Symptomatic treatment like platelet concentrate transfusions, fresh-blood transfusions and antipyretics were given to all cases. Oral Ribavirin was given only to the confirmed cases. It was started in a dose of 2 gm initially, followed by 1 gm 6 hourly for 4 days and then 500 mg 8 hourly for 6 days. After a mean period of 2.30+0.69 days of treatment with Ribarivin, the clinical as well as the laboratory parameters started improving and returned to normal levels after 10 -day course of treatment. Mild anaemia and thrombocytosis were seen as adverse effects in some of the patients. Conclusions: For treatment of this fatal disease, we recommend use of oral Ribavirin in all patients diagnosed to have CCHF in the above-mentioned doses, on the basis of our study results