RESUMO
Background: Acute myocardial infarction (AMI) management is one of the therapeutic challenges faced by the emergency physician. In the field of investigational cardiology advancements, the search of superior cardiac biomarkers has led to the discovery of sensitive biomarkers which help in the early confirmation of MI as timely intervention is the primary goal in acute coronary syndrome (ACS). Present study was aimed to evaluate the diagnostic performance of the novel biomarker H- FABP in patients with AMI especially in ST elevation MI (STEMI) and comparison of its diagnostic accuracy with the other biomarkers.Methods: We studied 66 patients with persistent STEMI presenting within 12 hours of symptom to the department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Puducherry. Quantitative and qualitative estimation and analysis of serum biomarkers of acute myocardial infarction such as CK-MB, cardiac Troponin I (cTnI) and H-FABP were done.Results: The sensitivity and specificity of H-FABP were 80.7 and 88.9% respectively. The positive percentage of the serum biomarkers among these patients were 64%, 65%, 86% for CK-MB, cardiac troponin I, and H-FABP respectively. The area under the curve was observed to be 0.695, with 95% confidence interval (0.514-0.876) at the optimum cut-off value of 7.0ng/ml for H-FABP.Conclusions: H-FABP the novel biomarker, because of its early appearance in the blood stream and due to its superior sensitivity and specificity compared to Troponin I and CK-MB can be used in the early diagnosis of acute ST elevation Myocardial Infarction
RESUMO
Background: Snakebite envenomation is an important public health problem faced by the tropical countries with India, the worst affected in terms of mortality and morbidity. In spite of increasing reports of other snake species causing envenomation, the existing research and management strategies including antivenom are still focused on the “Big Four” species- Russel’s viper, saw scaled viper, common krait and spectacled cobra. Pit vipers as a group are being increasingly reported to cause human bites from different parts of the country. Hence, we decided to study the clinico-epidemiology of pit viper bites.Methods: 30 cases of proven pit viper bites who attended our Department during the study period of 18 months were analysed for the epidemiological factors, clinical features and abnormalities in laboratory parameters.Results: Hump nosed pit viper (Hypnale hypnale) was responsible for all the thirty cases. 57% of cases were females. Mean age of victims was 41.8 years. 17 patients had exclusively local envenomation. Ten cases had coagulopathy along with local envenomation. Three patients developed acute kidney injury of whom three underwent dialysis. No mortality was observed in the study. Low fibrinogen levels were observed in all cases with coagulopathy and some had low levels of factor V (70%) and factor VIII (40%).Conclusions: Hump nosed viper bites were observed to be common in this part of the country. Significant envenomation can occur. Further epidemiologic studies involving more centres will be helpful in quantifying the true incidence of bites. Since no specific antivenom is available, further researches in this direction are warranted.