Evaluation of Heart Fatty Acid Binding Protein (H-FABP) As A Diagnostic Marker in Acute Coronary Syndrome

Background: Heart Type Fatty Acid Binding Protein (H-FABP) is a biomarker suggested for early detection of Acute Coronary Syndrome (ACS). Early diagnosis and management are critical as it could prevent and reduce morbidity and mortality. The study aimed to determine the diagnostic accuracy of H-FABP as a biomarker of ACS compared to gold standard high-sensitivity Troponin I (hs–TnI) and/or ECG findings suggesting ischemia. Methods: The study was conducted from May 2020 to November 2020 at Dr. Ziauddin University Hospital in Karachi. Blood samples of 154 patients were collected, who presented to an emergency department or admitted to the Cardiac Care Unit more than 18 years of age with symptoms suggesting angina as pain in the chest, left arm/lower jaw, increased heart rate and shortness of breath. Patient data regarding age, gender, duration of chest pain onset, kidney disease, diabetes mellitus, hypertension and smoking were collected. Serum H-FABP was analyzed on a Quantitative Fluorescence immunoassay Analyzer. Diagnostic accuracy statistics for H-FABP were calculated with the help of contingency tables taking hs-TnI and/or ECG findings as a gold standard. Results: Overall H-FABP showed sensitivity (91.0%), specificity (76.7%), PPV (90.9%), NPV (76.7%) and diagnostic accuracy was 87.58%. H-FABP demonstrated an Area Under Curve (0.911, 95% C.I:0.850-0.972, p<0.001), higher than that of hs-TnI (0.908, 95% C.I:0.844-0.971, p<0.001) in patients having chest pain for 3 hours or less, at the cost of specificity. Conclusion: H-FABP is a more sensitive biomarker than hs-TnI in the early diagnosis of ACS (p<0.001). However, being less specific, it can be used as an adjuvant cardiac biomarker for early diagnosis of ACS. Keywords: Diagnostic Accuracy, Acute Coronary Syndrome; Heart-Type Fatty Acid Binding Protein; Cardiac Biomarkers

Awareness and Use of Benzodiazepines in Healthy Volunteers and Ambulatory Patients Visiting a Tertiary Care Hospital: A Cross Sectional Survey

Background: Indiscriminate prescription of Benzodiazepines in Pakistan and subsequent availability over-the-counter without prescription is a major public health problem, requiring systematic inquiry through research. Additionally, there is limited data on the awareness and use of Benzodiazepines from developing countries making it impossible to devise meaningful health policies. Methodology/Principal Findings: This was an Observational, Cross-Sectional study. conducted at Aga Khan University. A total of 475 (58.5 % males, 41.5 % females) people visiting a tertiary care hospital were interviewed by means of a structured questionnaire. The results showed that majority of population was aware of one or more Benzodiazepines (80.4%) and 30.4 % had used them at some point in life. 42.4 % of the users had been using it for more than a year. Commonest reason for use was sleep disturbance. Frequency of usage was higher for females, married individuals, educated (.Grade12), high socioeconomic status and housewives. More (59%) were prescribed than not and of them most by GP (58.5%). Only 36.5% of them were particularly told about the long-term addiction potential by the use of these drugs. Conclusion: Easy availability, access to re-fills without prescription and self prescription compounded with the lack of understanding of abuse potential of benzodiazepines constitutes a significant problem demanding serious consideratio

Assessment of Relation Between Subjectıve Memory Complaınts and Objective Cognitive Performance of Elderly Over 55 Years Old Age

ABSTRACT Introduction: This study investigated the frequency of forgetfulness in elderly individuals over 55 years of age and examined the association of subjective memory complaints (SMCs) with objective cognitive functions,, depression and other risk factors

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Lived Experiences of Chronic Pain among Immigrant Indian Women in Canada

Chronic pain affects an estimated 1.5 million people in Canada (Canadian Pain Task Force, 2019). As recent immigrant status is a risk factor for the development and progression of chronic pain (Cimmino, Ferrone Cutolo, 2011), it is a particular concern for Canadian immigrant communities. Currently, the Indian population is the fastest growing immigrant group in the country (Statistics Canada, 2014). This makes them an important community in which to understand chronic pain – both its manifestations and its meaning – to ensure culturally-sensitive pain management (Weerasinghe Numer, 2010). As elsewhere in the world, the prevalence of chronic pain is higher among Indian women than men, with women also reporting more severe pain (Dureja et al., 2013). In countries other than India, Indian women also report more pain than non-Indian women (Chia et al., 2016; Allison et al., 2002). However, little is known about their lived experiences of chronic pain or the context in which their pain occurs. In order to fill these gaps, the current qualitative study explores: (1) Canadian immigrant Indian women’s lived experiences of chronic pain, and (2) the role culture plays in these experiences. Thirteen immigrant Indian women with chronic, non-cancer pain participated in this study. Women’s experiences were gathered using one-on-one interviews and photovoice methods. interviews and photographs were analyzed using van Manen’s (1990) phenomenological thematic analysis and Oliffe, Bottorff, Kelly and Halpin’s (2008) photograph analysis. Findings revealed the multidimensional nature of Indian women’s chronic pain, as well as the influence of the larger contexts of gender and immigration on their pain experiences. In particular, women discussed pain in relation to gendered roles and expectations. They also described the process of emigrating to a new country, adapting a new way of life, and adjusting to shifting roles as key factors affecting their pain experiences. These valuable insights have practical, as well as theoretical implications; they not only inform our current knowledge of pain within this understudied population, but also expand our understanding of pain’s biocultural components to include gender and immigration.Ph.D.2021-11-30 00:00:0

Effect of Diabetes Mellitus and Anti-Diabetic Drugs on Bone Health-A Review

Osteoporosis and diabetes mellitus (DM) are widespread diseases and have a significant health burden. Type-1 diabetes mellitus (T1DM) and Type-2 diabetes mellitus (T2DM) are associated with an increased bone fracture. In T1DM, the increased risk of bone fracture is associated with low bone mass. In patients with T2DM, the risk of fracture of the bone is increased due to low quality of bone, despite increased bone mineral density (BMD). In type 2 diabetic patients, bone fragility depends on the quality of bone instead of a reduction in bone mass. Thiazolidinediones (TZD) cause differentiation of adipocytes and inhibit differentiation of osteoblast and bone marrow stromal stem cells (BMSC). In this review, we have described the effect of anti-diabetic drugs and diabetes mellitus on bone health and our finding shows that sulfonylureas and metformin have no negative effect on bone health and protect bones against fractures

Influence of narrowband UVB irradiation of serum on autologous serum skin test results

Background Autologous serum skin test (ASST) is an in vivo test to demonstrate circulating endogenous proinflammatory or wheal-inducing factors in urticaria patients. While ASST was negative in a patient with solar urticaria and in a patient with localized heat urticaria, test results turned to positive when performed with visible light-irradiated and heated serums, respectively. These data suggest that some factors and/or antibodies in serum may be activated or inhibited with different factors. We aimed to investigate whether or not ASST results change when performed with narrowband ultraviolet B (UVB)-irradiated serum. Materials and methods Seventy-seven patients with chronic idiopathic urticaria underwent ASST twice in consecutive days. The second ASST was performed with narrowband UVB-irradiated serum. The results of the first and second ASSTs were compared. Results The first ASST results were positive in 46 (59.7%) patients. ASST results reversed oppositely in 36 (46.8%) patients, turned from negative to positive in 19 patients, and turned from positive to negative in 17 patients when performed with narrowband UVB-irradiated serum. Conclusion Our results suggest that narrowband UVB may have modifying effects on some wheal-inducing factors and/or antibodies. On which factors in serum narrowband UVB has effects may be investigated. © 2013 The International Society of Dermatology