Assessment of Clinical, Risk Factors Profile and Clinical Pharmacist Care Services on Management and Prevention of Coronary Artery Disease Complications Among Diabetic Patients in a Tertiary Care Hospital Practice

@#Introduction: Diabetes is a chronic metabolic disease and noted to be incidence is intensifying globally and contemplated as epidemic. The study is aimed to assess the coronary artery disease risk profile associated diabetes mellitus patient and to identify the clinical pharmacist care services in the management and to control the risk burden in the clinical practice. Method: A prospective observational study was conducted among the consecutive patients of coronary artery disease associated diabetic patients in a tertiary care teaching hospital over 6 months period. A sample of 150 patients was recruited in the study. Data analysis was done with graph pad prism software 5.01. Results: The present study revealed that coronary artery disease in diabetes was more prevalent in age group between 41-50 years. About 54.66% patients with hyperlipidemia were at risk to develop the coronary artery disease complication. Glycated hemoglobin test was detected in 40% of the patient showing abnormal levels and around 43.33% of patient had an abnormal fasting blood sugar level. The study showed only 32% of patients was prescribed Insulin & oral hypoglycemic agents and 13 % were treated with statins. Conclusion: It could be concluded that the causative factors should be controlled and treated with an early need for amalgamation of clinical pharmacist care services with the health care team on life style modification counseling could ultimately improve the patient health outcomes and also lowers progression of coronary artery disease risk complications among diabetic patients.

FUNCIONALIDAD FAMILIAR DESDE LA PERSPECTIVA DE UN INTEGRANTE CON DIABETES MELLITUS TIPO 2 EN LA SIERRA NEGRA DE PUEBLA / FAMILY FUNCTION FROM THE VIEWPOINT OF A MEMBER WITH TYPE 2 DIABETES MELLITUS IN THE SIERRA NEGRA DE / PUEBLA FUNCIONALIDADE FAMILIAR SOB A ÓTICA DE UM MEMBRO COM DIABETES MELLITUS TIPO 2 EM SIERRA NEGRA DE PUEBLA

Objetivo: identificar y Describir la Funcionalidad Familiar de Adultos con DMT2 en la Sierra Negra de Puebla. Métodos: el diseño fue descriptivo, transversal, el muestreo probabilístico aleatorio simple. La muestra fue de 118 adultos con diagnóstico de DMT2. La recolección de la información fue mediante una cédula y la Escala de Efectividad en el Funcionamiento Familiar. Resultados: el rango de edad de los adultos fue de 41-59 años, predominó el sexo femenino con el 78%, el 80.6% cuenta con seguro popular, de ocupación ama de casa con el 48.4%. Con respecto a las características sociodemográficas de las familias de los adultos con DMT2, predomina la familia nuclear con el 63.5%, con 4 a 5 integrantes en la familia en el 50%. En el propósito planteado se encontró que el 61.9% tuvo una funcionalidad familiar moderada. Conclusión: la relación de la FF y FF moderada versus disfunción familiar es de casi 2.3:1 lo que indica que en la sierra negra de Puebla aún se encuentran familias integradas aun en estadios de enfermedad crónica como la DMT2.

Objective: identify and describe the Family Functionality of Adults with DMT2 in the Sierra Negra of Puebla. Method: the design was descriptive, cross-sectional, random simple probabilistic sampling. The sample consisted of 118 adults diagnosed with DMT2. The collection of the information was through a cedula and Scale of Effectiveness in the Familiar Functioning. Results: the age range of the adults was 41-59 years, predominantly the female sex with 78%, the 80.6% with the popular insurance, occupancy of the housewife with 48.4%. With regard to the sociodemographic characteristics of the families of adults with T2DM, the nuclear family predominates with 63.5%, with 4 to 5 members in the family in 50%. In the purpose presented, 61.9% had moderate family functionality. Conclusion: the relationship between FF and FF against moderate family dysfunction is about 2.3: 1, indicating that in Sierra Negra de Puebla still integrated families are found even in stages of the chronic disease like DM2.

Objetivo: identificar e descrever a funcionalidade familiar de adultos com DM2 em Sierra Negra de Puebla. Método: o desenho foi descritivo, transversal, amostragem probabilística aleatória simples. A amostra foi composta por 118 adultos diagnosticados com DM2. A coleta de informações foi através de uma cédula e da Escala de Efetividade do Funcionamento Familiar. Resultados: a faixa etária dos adultos foi de 41-59 anos, o sexo feminino predominou com 78%, 80,6% possuíam seguro popular e 48,4% eram donas de casa. Em relação às características sociodemográficas das famílias de adultos com diabetes mellitus tipo 2, a família nuclear predominou com 63,5%, com 4 a 5 membros da família em 50%. Na presente propósito verificou-se que 61,9% tiveram um funcionamento familiar moderado. Conclusão: a relação entre o FF e FF contra disfunção familiar moderada é de cerca de 2.3:1, indicando que em Sierra Negra de Puebla ainda se encontram famílias integradas mesmo em estágios da doença crônica como DM2.

Incidência de aterosclerose obliterante periférica em pacientes com doença coronariana / Incidence of peripheral artery disease in coronary patients

Introdução: Pacientes com doença coronariana, cuja principal causa é a aterosclerose, podem também desenvolver Doença Arterial Obstrutiva Periférica (DAOP). Objetivo: Analisar a incidência de DAOP em pacientes com doença arterial coronariana, relacionando com o número de artérias obstruídas. Material e métodos: Participaram deste estudo 48 pacientes com doença coronariana submetidos a cineangiocoronariografia com angioplastia e implante de stent coronariano, no período de janeiro de 2008 a junho de 2009, em um hospital de atendimento exclusivo do Sistema Único de Saúde (SUS) da cidade de Presidente Prudente, SP, Brasil. Foram avaliados dados demográficos, presença de patologias concomitantes e fatores de risco cardiovasculares, e realizada a aferição do Índice Tornozelo-Braquial (ITB). Foi realizada análise descritiva dos resultados. Resultados: A idade média foi de 59,5 ± 8,2 anos, sendo 64,6% do sexo masculino. O diabetes mellitusesteve presente em 37,5% dos pacientes, a hipertensão arterial sistêmica em 89,6%, a dislipidemia em 64,6% e o tabagismo em 52,1%. Na cineangiocoronariografia, houve predomínio de lesão na artéria descendente anterior (n=37; 77,1%), seguida pela coronária direita (n=24; 50%), primeira diagonal (n=16; 33,3%) e circunflexa (n=12; 25%). Dos avaliados, 19 pacientes (40%) tiveram o ITB alterado em, no mínimo, um membro. Conclusão: Em pacientes com doença coronariana e fatores de risco cardiovasculares, a DAOP foi altamente incidente. Porém, este estudo não observou correlação do ITB com a quantidade de artérias obstruídas. Considerando que os fatores de risco observados são mutáveis e plausíveis de serem controlados ou erradicados, como o tabagismo, é necessário que a atenção básica seja estimulada à busca ativa destes pacientes na comunidade, intensificando as estratégias de controle da hipertensão arterial sistêmica, da dislipidemia, do diabetes mellitus e do tabagismo.

Introduction: Patients with coronary disease whose primary cause is atherosclerosis may also develop Peripheral Arterial Disease (PAD). Objective: To analyze the incidence of PAD in patients with coronary artery disease, related to the number of obstructed arteries. Materials and methods: The study included 48 patients with coronary artery disease undergoing coronary angiography with angioplasty and coronary stenting, from January 2008 to June 2009, in a hospital serving exclusively the Unified Health System (SUS) in Presidente Prudente, SP, Brazil. Demographics, presence of concomitant diseases and cardiovascular risk factors were assessed and performed, and the Ankle Brachial Index (ABI) was measured. Descriptive Analysis of results was performed. Results: Mean age was 59.5 ± 8.2 years, 64.6% were males. Diabetes mellitus was present in 37.5% of patients, systemic arterial hypertension in 89.6%, dyslipidemia in 64.6% and smoking in 52.1%. In coronary angiography, there was a prevalence in lesion in the anterior descending artery (n=37; 77.1%), followed by the right coronary artery (n=24; 50%), first diagonal (n=16; 33.3%) and circumflex (n=12; 25%). Of the patients evaluated, 19 (40%) presented an altered ABI in at least one member. Conclusion: In patients with coronary disease and cardiovascular risk factors, the PAD was highly incident. However, this study found no correlation between the ABI and the quantity of obstructed arteries. Considering that the risk factors observed are changeable and plausible to be controlled or eradicated, such as smoking, it is necessary that primary care is encouraged so that there is an active search of these patients in the community, intensifying strategies for control of systemic arterial hypertension, dyslipidemia, diabetes mellitus and smoking

Circulating miRNAs as diagnosis biomarkers for cardiovascular diseases / 第二军医大学学报

MicroRNAs (miRNAs) are a group of endogenous small non-coding RNAs, which play important gene regulatory roles at the posttranscriptional level by binding to the 3′ untranslated region of the targeted mRNAs. MiRNAs possess tissue-specific signatures and have been found involved in various pathophysiological processes. Recent reports have demonstrated that miRNAs are stably present in blood circulation in the form of microvesicles, exosome, microparticle, and apoptotic bodies; and the plasma levels of specific miRNAs have been proven as potential biomarkers for diagnosis and prognosis of cancers. Many articles have also reported that miRNAs can serve as important diagnostic biomarkers for cardiovascular diseases. Here we reviewed the roles of circulating miRNAs as potential biomarkers for cardiovascular diseases, including acute myocardial infarction, heart failure, coronary artery disease, and diabetes mellitus.

Serum high-sensitivity C-reactive Protein and Lipoprotein(a) Levels: A comparison between Diabetic and Non-diabetic Patients with Coronary Artery Disease

Objective: The aim of this study was to compare highsensitivity C-reactive protein (hsCRP) and Lipoprotein(a) levels [Lp(a)] levels between diabetic and non-diabetic patients with coronary artery disease (CAD). Study Design: Cross sectional Study. Place and Duration of study: This study was conducted in the department of Physiology of College of Medicine & King Khalid University Hospital, King Saud University, Riyadh between August 2006 and December 2007. Methods: One hundred and three individuals with CAD and 30 healthy individuals matched for age and BMI were studied. CAD patients were divided into two groups based on presence (n=62) and absence (n=41) of type 2 diabetes mellitus. Overnight fasting blood samples were collected, and analyzed for total cholesterol (TC), Triglycerides (TG), Low density Lipoprotein (LDL) and High density lipoprotein (HDL), Lp(a) and hsCRP. Data about CAD severity was obtained from medical records. Results: Both groups of CAD without and with DM had significantly higher levels of Lp(a) [mg/dl] (25.58 ± 25.99, 25.90 ± 24.67 respectively) and hsCRP [mg/dl] (0.52 ± 0.71, 0.82 ± 0.78 respectively) when compared with healthy control subjects (Lp(a) =16.93 ± 15.34 & hsCRP=0.27 ± 0.21) [p<0.05]. Lp(a) levels between the two CAD groups were non significant. While, hsCRP levels were significantly high in CAD with DM compared to those without DM [p<0.05]. Gensini Score of CAD severity was also higher in CAD with DM [67.60 ± 45.94] than those without DM [52.05 ± 42.27, p<0.05]. Conclusion: Elevated Lp(a) and hsCRP levels are associated specifically with angiographically defined CAD. However, hsCRP elevation but not Lp(a) is also associated with CAD in type 2 diabetes mellitus. Measurement of hsCRP and Lp(a) may be considered optional markers for better prediction of cardiovascular risk.