Evaluation of Glycated Hemoglobin (HbA1c) in Acute Coronary Syndrome (ACS)

Aim:The aim of our study was to estimate the level of HbA1c in patients with Acute Coronary Syndrome (ACS). To determine any correlation between HbA1c, admission blood glucose (Random blood sugar), serum lipid profile among the cases and to evaluate the outcome during hospitalization. Study Design and Setting:Cohort study.Place and Duration of the Study:Department of Biochemistry and General Medicine including ICCU and Cardiology unit, RIMS, Imphal, between September 2015 to August 2017.Methodology:Data were collected from 98 patients admitted in Medicine ward who were diagnosed with ACS irrespective of their diabetes status and they were divided into three groups according to their HbA1c levels (<5.7%, 5.7-6.4%, > 6.5%). The blood samples collected by venipuncture were analyzed for HbA1c level, done by RANDOX HbA1c Rx series (latex agglutination inhibition assay), admission blood glucose (measured by Trinder’s method) and serum lipid profile (RANDOX enzymatic Endpoint Method Rx series). The data were analyzed using statistical tools like Chi Square test, Independent sample t test, Pearson’s Correlation, Fisher’s exact test through SPSS 21.0.Results:Majority of the patients were men (72.4%) & (27.6%) women and in the age group of 51-65 years. The mean ageis 62.14 years. 54.1% of the ACS patients were already diagnosed cases of type 2 diabetes mellitus whereas 45.9% were non-diabetic. Out of 98 patients, 60 had HbA1c level in the diabetic range (≥6.5%), 25 in the pre-diabetic range (5.7-6.4%) and the remaining 13 were within normal range (<5.7%). Admission blood glucose, total cholesterol and LDL were positively correlated with HbA1c value. Conclusion:The mortality of the ACS patients irrespective of diabetic status during hospitalization was associated with HbA1c value irrespective of diabetic status during hospitalization. However, it was not associated with thirty days mortality

Body Iron Stores and Cardiovascular Health.

A substantial body of epidemiological and experimental data suggests the significance of serum iron as an important cardiovascular risk factor. There are many conflicting reports on the hypothesis that body iron stores are associated with risk of coronary heart disease. The likely mechanism by which iron may play a pathogenic role in cardiovascular disease has been postulated. The recent discovery of the HFE C282Y mutation commonly seen in hereditary hemochromatosis and its reported association with increased risk of coronary heart disease has increased the need to evaluate its role in the development of cardiovascular disease. Overall, understanding the role of iron in relation to cardiovascular health may be an important tool to help stratify risk for cardiovascular disease.

Depression, Inflammatory Process and Medical Disorder.

Depression is well recognized as a major public health problem throughout the world. This article efforts to explore a pathway that links depression, inflammatory process and medical disorder. Associations linking inflammation and chronic immune activation with depression have been found, particularly in medical disorders with inflammatory pathopathyology. Acute coronary syndrome is given as an example of how the inflammatory process might result in depression.

Oral ranolazine in the conversion of paroxysmal and initial onset atrial fibrillation.

Background: Atrial fibrillation (AF) is the most common arrhythmia requiring treatment. High-dose oral anti-arrhythmics (mainly class 1C or quinidine) are used as “pill in the pocket” approach to convert recent onset AF. However pro-arrhythmic risk has limited the application of this approach in many patients. Ranolazine, an antianginal agent, which inhibits abnormal late Na+ channel currents, decreases sodium-calcium overload, potentially inhibits after-depolarisations which have been implicated in the initiation and propagation of AF. Methods: Two gramme ranolazine was given orally to 40 patients with new (first detected episode of AF, 16 patients) or paroxysmal (3 hours to 72 hours duration, 24 patients) AF. Twenty-four patients were in hospital, 6 in office, and 10 at home at the time of ranolazine administration. Age, sex, associated health condition, structural heart disease (SHD) and echocardiographic criteria were recorded. Treatment for other related conditions was also given. Successful conversion was defined as restoration of sinus rhythm within 6 hours of ranolazine administration. Results: Twenty-six of 40 patients (65%) converted to sinus rhythm. No pro-arrhythmic effects, haemodynamic instability, adverse effects, or perceived intolerance were noted. Conclusion: High-dose oral ranolazine shows utility as a possible safe agent to convert new or paroxysmal AF.