Predicting outcomes in acute coronary syndrome using biochemical markers.

OBJECTIVES: To assess risk prediction in patients with acute coronary syndrome (ACS) during the hospital stay, at 6 weeks and at 6 months period using high sensitivity C-reactive protein (hs-CRP), serum creatinine, cardiac troponin I, creatine kinase total, and MB levels. METHODS: It was a prospective observational study. The primary outcome was taken as all-cause mortality. Patients with ACS were enrolled and followed up at 6 weeks and 6 months duration from the index event. Mortality and cause of death were recorded. The hs-CRP was estimated on admission, at 6 weeks, and at 6 months. The estimated glomerular filtration rate (eGFR) was calculated using the abbreviated modification of diet in renal disease (MDRD) formula at admission, at 6 weeks, and 6 months. RESULTS: There were a total of 108 cases of ACS in the duration of 6 months who completed the follow-up. The hs-CRP level of >5mg/dl was highly significant for predicting mortality during hospital stay and at 6 weeks (p<0.001). There was 11% of in-hospital mortality (p<0.001). At 6 months, the overall mortality was 28% (p<0.001). There was a statistical significance with low eGFR (median eGFR 45ml/min/1.73m(2)) levels during the admission. CONCLUSION: hs-CRP levels above 5mg/dl and the eGFR levels ≤30ml/min/1.73m(2) were significant in predicting mortality of the patients with ACS. This may provide simple assessment tools for predicting outcome in ACS in resource-poor settings if validated further.

Patients' Awareness about the Complications of Diabetes Mellitus and its Co-relation with the Glycemic Status.

INTRODUCTION: Diabetes is a major cause of morbidity and cardiovascular related mortality along with a major cause of preventable blindness and foot amputation. There are limited studies on diabetes awareness, attitude, and prevalence. METHODS: Thus, we designed a study to seek the patients awareness about the complications associated with diabetes. It was a prospective observational study which included 123 patients with Diabetes Mellitus. RESULTS: The mean age of population studied was 53 years mainly from the Rupandehi and Nawalparasi districts in Nepal attending a clinic. In the study Erectile Dysfunction was statistically significant with postprandial hyperglycemia. Lack of Awareness about a calorie specific diet plan was significantly associated with increased blood sugar fasting level >110mg/dl. A majority of patients (58%) had awareness regarding kidney damage and 51% had awareness that Diabetes causes delayed wound healing. Only 3% of the patients did a regular foot care and 9% knew what the target glycemic status is. About 36% know that there can be cardiac complications due to diabetes and 27% regarding eyes. Similarly 36% of the patients also knew that there is neuropathy due to diabetes and 18% were aware about CVA. About 54% of the patients had Fasting >110mg%. CONCLUSION: The study showed that though the patients are on OADs but they lack awareness about the major complications related to diabetes mellitus.

Clinico-epidemiological Study on Pesticide Poisoning in a Tertiary Care Hospital in Eastern Nepal.

INTRODUCTION: Pesticide poisoning is a major health problem worldwide. In Nepal the most common cause is suicidal and pesticides account for more than fifty percent of cases. The objective of the study was to look in detail regarding the pesticide poisoning cases admitted at BPKIHS; their epidemiological profile, presentation, treatment and their outcome during the hospital stay. METHODS: It was a retrospective study which included 2621 patients with poisoning of which 1661 cases were related to pesticides. RESULTS: The mean duration of hospital stay was 6.7 days. The majority of patients 81.16% showed improvement whereas 6.6% of patients died within 24 hours of admission and 3.54% after 48 hours of admission. Among all the patients 0.5% patients were given ICU care and all others were managed in the different units of medicine ward. The total amount of atropine administered varied considerably. Most of the cases were under the influence of alcohol. All the patients had a psychiatry evaluation before discharge. CONCLUSIONS: Pesticide poisoning is increasing in incidence and it is one of the preventable public health problems and includes mainly the patients' age group 20-30 years. Due to easy availability of pesticides it is the most preferred method of suicide and the main reasons being impulsive act and increased indebtedness in the society.

Chronic cough in thymoma.

Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis.