Qualitative assay of C-reactive proteins in acute coronary syndromes

Introduction: Acute coronary syndromes (ACS) are the major causes of mortality in coronary care units. Inflammation plays an important role in ACS.  C-reactive protein (CRP) is one of the inflammatory markers, which plays a key role in the pathogenesis. This study aimed at assessing C-reactive protein levels in acute coronary syndromes, and determining its significance in prognosis. Methods: Fifty patients admitted with the diagnosis of ACS were included in the study. Qualitative C - reactive protein assay was done at the time of admission. Patients were followed up for the complications till discharge. Results: Age group between 41 to 70 years constituted 40 (80%) patients. Out of 50 patients with acute coronary syndromes 36 patients had elevated CRP. Thirty patients (83.33%) of them met with complications. Of the 14 patients with low CRP only two (14.28%) patients met with the complications. Conclusions: Qualitative plasma CRP estimation gives valuable prognostic information in acute coronary syndromes

Knowledge, attitudes, and practices of public sector primary health care physicians of rural north karnataka towards obesity management

Introduction: Obesity is a risk factor for cardiovascular disease (CVD), diabetes mellitus (DM), and hypertension (HTN). In an era of rapidly growing prevalence of obesity, it is important to explore the current knowledge, attitude, and practices of primary care physicians. Materials and Methods: Study participants were medical officers (MOs) of primary health centers in three districts of North Karnataka. The questionnaire was developed by a review of literature in the field and validated with five participants for scope, length, and clarity. Results/Discussion: Of the 102 participants, only 15% were aware about the burden of obesity in India. HTN, DM, and CVD were indicated as comorbidities by 73, 78, and 60 participants, respectively. Only 25 and 12 participants indicated appropriate body mass index (BMI) cut-off values for overweight and obesity diagnosis. Of the 102 participants, 54 were not aware of the guidelines for obesity management. Practices and attitudes of the participants were encouraging. Nearly all of them felt that the adults with BMI within the healthy range should be encouraged to maintain their weight and, three-fourth of them agreed that most overweight persons should be treated for weight loss and small weight loss can achieve major medical benefit. However, nearly half of the participants′ responses were stereotypical as they felt only obese and overweight with comorbidities should be treated for weight loss. Two-thirds of them use BMI to diagnose overweight/obese and nearly all of them advice their patients to increase physical activity and restrict fat. Most of the participants were advising their patients to restrict sugar intake, increase fruits and vegetable consumption, reduce red meat, and avoid alcohol consumption. Conclusion: Present study exposed the lack of knowledge regarding obesity. However, practices and attitudes of the participants were promising. There is a need of in-service training to MOs to further improve their knowledge and practices towards management of obesity

Performance of diabetes risk scores with or without point of care blood glucose estimation

Context: Early detection and optimal treatment of type 2 diabetes mellitus (T2DM) are shown to prevent or delay the complications of the disease. In resource poor settings we need sensitive, specific and inexpensive screening tool to detect people with T2DM. Tools involving point of care blood glucose testing have shown the superiority over others where only history and anthropometry were used. Aims: This study aims to compare the specificity and sensitivity of Indian diabetes risk score (IDRS) and Tabaei and Herman equation based risk score model in a rural community of Northern Karnataka. Materials and Methods: Diabetes prevalence study conducted in rural North Karnataka is used for the present study. All the variables required for calculating IDRS and Tabaei and Herman equation are available from the prevalence study. Instead of random capillary blood glucose, 2 h post 75 g plasma glucose value is used in the equation. And self-reported postprandial time is taken as 2 h. Statistical Analysis: The MedCalc-version 11.3.0 is used for the statistical calculations. DeLong method used to compare the area under receiver operating characteristics (ROCs) of the two risk scores. Results: Three hundred and eighteen participants completed the study and were considered for analysis. In this study optimal, cut-off value for IDRS found to be 40 and for Tabaei et al. equation 0.09. Area under ROC for IDRS was 0.755 (95% CI: 0.680-0.819), and for Tabaei et al. equation it was 0.979 (95% CI: 0.943-0.995). Conclusion: Sensitivity and specificity of T2DM screening tool can be improved by including a point of care blood glucose testing

Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy The SCARLET Randomized Clinical Trial

Importance: Previous research suggested that soluble human recombinant thrombomodulin may reduce mortality among patients with sepsis-associated coagulopathy. Objective: To determine the effect of human recombinant thrombomodulin vs placebo on 28-day all-cause mortality among patients with sepsis-associated coagulopathy. Design, Setting, and Participants: The SCARLET trial was a randomized, double-blind, placebo-controlled, multinational, multicenter phase 3 study conducted in intensive care units at 159 sites in 26 countries. All adult patients admitted to one of the participating intensive care units between October 2012 and March 2018 with sepsis-associated coagulopathy and concomitant cardiovascular and/or respiratory failure, defined as an international normalized ratio greater than 1.40 without other known etiology and a platelet count in the range of 30 to 150 × 10 9/L or a greater than 30% decrease in platelet count within 24 hours, were considered for inclusion. The final date of follow-up was February 28, 2019. Interventions: Patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06 mg/kg/d [maximum, 6 mg/d]; n = 395) or matching placebo (n = 405) once daily for 6 days. Main Outcome and Measures: The primary end point was 28-day all-cause mortality. Results: Among 816 randomized patients, 800 (mean age, 60.7 years; 437 [54.6%] men) completed the study and were included in the full analysis set. In these patients, the 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group (106 of 395 patients [26.8%] vs 119 of 405 patients [29.4%], respectively; P =.32). The absolute risk difference was 2.55% (95% CI, -3.68% to 8.77%). The incidence of serious major bleeding adverse events (defined as any intracranial hemorrhage; life-threatening bleeding; or bleeding event classified as serious by the investigator, with administration of at least 1440 mL [typically 6 units] of packed red blood cells over 2 consecutive days) was 23 of 396 patients (5.8%) in the thrombomodulin group and 16 of 404 (4.0%) in the placebo group. Conclusions and Relevance: Among patients with sepsis-associated coagulopathy, administration of a human recombinant thrombomodulin, compared with placebo, did not significantly reduce 28-day all-cause mortality. Trial Registration: ClinicalTrials.gov Identifier: NCT01598831

Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy The SCARLET Randomized Clinical Trial

Importance: Previous research suggested that soluble human recombinant thrombomodulin may reduce mortality among patients with sepsis-associated coagulopathy. Objective: To determine the effect of human recombinant thrombomodulin vs placebo on 28-day all-cause mortality among patients with sepsis-associated coagulopathy. Design, Setting, and Participants: The SCARLET trial was a randomized, double-blind, placebo-controlled, multinational, multicenter phase 3 study conducted in intensive care units at 159 sites in 26 countries. All adult patients admitted to one of the participating intensive care units between October 2012 and March 2018 with sepsis-associated coagulopathy and concomitant cardiovascular and/or respiratory failure, defined as an international normalized ratio greater than 1.40 without other known etiology and a platelet count in the range of 30 to 150 × 10 9/L or a greater than 30% decrease in platelet count within 24 hours, were considered for inclusion. The final date of follow-up was February 28, 2019. Interventions: Patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06 mg/kg/d [maximum, 6 mg/d]; n = 395) or matching placebo (n = 405) once daily for 6 days. Main Outcome and Measures: The primary end point was 28-day all-cause mortality. Results: Among 816 randomized patients, 800 (mean age, 60.7 years; 437 [54.6%] men) completed the study and were included in the full analysis set. In these patients, the 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group (106 of 395 patients [26.8%] vs 119 of 405 patients [29.4%], respectively; P =.32). The absolute risk difference was 2.55% (95% CI, -3.68% to 8.77%). The incidence of serious major bleeding adverse events (defined as any intracranial hemorrhage; life-threatening bleeding; or bleeding event classified as serious by the investigator, with administration of at least 1440 mL [typically 6 units] of packed red blood cells over 2 consecutive days) was 23 of 396 patients (5.8%) in the thrombomodulin group and 16 of 404 (4.0%) in the placebo group. Conclusions and Relevance: Among patients with sepsis-associated coagulopathy, administration of a human recombinant thrombomodulin, compared with placebo, did not significantly reduce 28-day all-cause mortality. Trial Registration: ClinicalTrials.gov Identifier: NCT01598831