Efficacy of serum blood urea nitrogen, creatinine and electrolytes in the diagnosis and mortality risk assessment of patients with acute coronary syndrome

Background Although blood urea nitrogen (BUN), creatinine (Cr) and electrolytes are not the mainstay of diagnosis in acute coronary syndrome (ACS) patients but they may have a role in providing a more detailed view of the complications and mortality rates. The aim of this study was to determine the efficacy of these parameters in the diagnosis and mortality risk-assessment of patients with ACS. Methodology A total of 200 patients with ACS were recruited in this prospective study. The relationship of serum BUN, Cr and electrolytes with cardiac enzymes, Global Registry of Acute Coronary Events (GRACE) and mortality was assessed during a 6-months follow-up. Statistical test like multivariate linear regression and binary logistic regression analysis were applied. Results On multivariate linear regression analysis, serum potassium (K) (Unstandardized Coefficient B = −3.77; p = 0.04) showed significant negative association with Creatine Kinease and serum BUN (Unstandardized Coefficient B = 0.52; p = 0.001) showed significant positive association with Troponin I. The patients with GRACE > 105 had significantly higher levels of serum BUN and Cr. Receiver operating characteristic curves showed that area under curve (AUC) of BUN (0.7) was higher than AUC of Cr (0.5). Multiple adjusted model showed that patients with BUN > 32.5 mg/dl were almost 20 times more likely to be associated with mortality as compared to reference group. Conclusion In addition to cardiac enzymes, K along with BUN and Cr may serve as important aid in diagnosis of ACS. BUN and Cr may also serve as important tools in mortality-risk assessment of ACS patients.

Visceral leishmaniasis: a cause of pyrexia of unknown origin

Objective: To determine the cause of pyrexia of unknown origin

Study Design: Cross-sectional study

Setting: The subjects for this study were enrolled at the private setup in northern areas of Gilgit and Hyderabad from January 2006 to December 2007

Method and Material: All patients presenting with pyrexia unresponsive to antibiotic and antimalarial therapies with negative serology for salmonella, malaria, tuberculosis and brucellosis underwent bone marrow aspiration. The specimens were analyzed at Armed Force Institute of Pathology [AFIP] Rawalpindi and Department of Pathology, Liaquat University of Medical and Health Sciences [LUMHS] Jamshoro. Patients were treated on the basis of microscopic findings and observations were recorded

Result: Among total 77 subjects 72 [98.51%] were of <8-years age and 5 [6.49%] were of 8-25 years age. Males were 53 [68.83%] and females were 24 [31.17%]. Microscopic examination reported all 77 specimens as amastigote positive. Subjects became symptom-free after anti-leishmaniasis therapy

Conclusion: Patients belonging to the Northern areas and Azad Kashmir living anywhere in Pakistan, not responding to antibiotics and antimalarial treatment with negative serology for salmonella, brucellosis, tuberculosis and malaria should be considered for visceral leishmaniasis and be investigated and treated promptly

Frequency and clinical presentation of dengue fever at tertiary care hospital of Hyderabad/Jamshoro

Objectives: The aim of this study is to observe the clinical presentation and frequency of dengue as a cause of fever in our setup

Methods: This retrospective study comprising of clinically suspected dengue infection, admitted to Liaquat University Hospital Hyderabad, during an epidemic from August 2006 to August 2007. Only adults with acute febrile illness were evaluated for clinical features of dengue fever, dengue hemorrhagic fever and dengue shock syndrome

Results: Patients with acute febrile illness were evaluated during this study. Fifty [5%] patients presented with typical features of dengue fever. Age of the patients ranged between 13 and 70 years. All patients were males with mean age of 35 years. Only 20/50 [40%] were dengue proven while 30/50 [60%] were dengue suspected. Out of dengue proven, 18 patients had dengue fever and 2 had dengue hemorrhagic fever. Typical clinical features included chills and rigors in 16 [80%], myalgia in 14 [70%], vomiting in 12 [60%], headache in 10 [50%], rash in 5 [25%]. Unusual clinical features were pharygitis in 7 [35%] and bleeding manifestations in 5% of patients. Laboratory investigations showed leucopenia [<4.0x10[9]/L] in 80%, thrombocytopenia [<150x10[9]/L] in 90%, and serum ALT was elevated [>40 U/L] in 40% cases

Conclusions: Fever associated with chills and rigors, bodyaches, bone pain, headache, myalgia, rash, low platelet count, decreased total leukocyte count, raised serum ALT, and hemorrhagic manifestations are satisfactory and important parameters to screen the cases of suspected dengue virus infection; however the diagnosis cannot be confirmed unless supported by molecular studies or dengue specific IgM