Cardiac troponin T and end stage renal disease.

OBJECTIVE: The aim of this study is to investigate the relationship between serum concentration of cardiac troponin T (cTnT) and other cardiac markers and ischemic heart disease (IHD) in end stage renal disease (ESRD) patients on chronic hemodialysis (HD). METHODS: This study was carried out at King Fahd Specialist Hospital, Buraidah, Kingdom of Saudi Arabia from July 2002 to September 2003. Cardiac troponin T was measured using Elecsys 2020 immunoassay system, a method that is specific for cTnT. The analytical range of cTnT assay was 0.01-25.0 ug/L. Seventy-three patients were divided into 4 groups: 20 patients with history of IHD, 17 patients with diabetes, 19 patients with diabetes and IHD and 17 patients without evidence of myocardial damage. RESULTS: Cardiac troponin T concentrations were > or =0.1 ug/L in 58% of HD patients. Fifty-three percent of diabetic patients had an increased cTnT, 37% of IHD patients had an increased cTnT, 59% of IHD and diabetic patients had an increased cTnT and 29% of noncardiac disease patients had an increased cTnT. Cardiac troponin T was increased more frequently in post-hemodialysis samples (13% pre-hemodialysis and 21% post-hemodialysis). CONCLUSION: Dialysis may alter measured cTnT concentrations in ESRD patients undergoing chronic dialysis. Sporadic or persistently increased cTnT appear to be the most specific of the currently available biochemical markers to predict subclinical myocardial damage in ESRD patients.

Audit of structure, process, and outcome of diabetic care at Al asyah primary health care centre, qassim region, saudi arabia.

OBJECTIVE: To assess the quality of diabetic care in Al-Asyah primary health care (PHC) center, Qassim region, KSA , through an auditing of structure, process, and outcome. METHODOLOGY: The files of all registered diabetic patients in this PHC center were reviewed. The indicators for structure were evaluated according to the National Quality Assurance protocol and manual of chronic diseases, and those for process were assessed by a modified scoring system. The outcome indicators were evaluated using the recommendations of American Diabetic Association (ADA) 2002. RESULT: Dietician, diabetic educator and Hb A1C, HDL level, LDL level were the most common non available resources. Out of 4628 patients registered in this PHC center, only 159 patients had diabetes. The prevalence of diabetes among registered adults aged 15 years and above was 5.8% and this increased with age. The patients were mostly Saudi (96.2%) and married (75.5%). They included 83 females (52.2%). The mean age was 56 years. Most of the patients were Type 2 (95.6%) and most were diagnosed at the PHC center (94.3%). The mean duration of the diabetes since diagnosis was 6.4 years. All checked process items showed high percentages of coverage (73% and above) except for the examination of the fundus, and the measurement of the triglyceride levels. Results showed that most of the samples were obese or overweight (49.7% and 32.7% respectively). While 21.4% had good diabetic control, 42.8% had poor diabetic control. Patient compliance to appointment was good (98.1%), and 13% of the diabetic patients had at least one reported complication. CONCLUSION: This study proves that some essential resources needed for diabetic care were inadequate. Provision of these resources is essential for the improvement of the quality of health care for diabetic patients. Also, there is a need to improve the referral system and establish an appropriate health education program to encourage patients, their families and the community to follow a more healthy life-style.