Correlation of red cell distribution width with inflammatory markers and its prognostic value in patients with diabetes and coronary artery disease

Background. Recent studies have shown red blood cell distribution width (RDW) as a marker for severity and prognosis in coronary artery disease patients. Other studies have also correlated RDW with diabetes mellitus and inflammation. However, such correlation and prognosis in patients with concomitant coronary artery disease and diabetes after percutaneous intervention remains unclear. Material and methods. Our study group comprised of 730 subjects including 700 patients (cases) and 30 normal subjects (control group). Patients who presented with coronary artery disease were divided into diabetic and non-diabetic groups. All patients had RDW measured at admission and percutaneous intervention was done. Follow-up for adverse events was carried out between 6 to 12 months. Results. RDW was elevated in patients as compared to control group (p < 0.05). RDW correlated well with inflammatory markers including erythrocyte sedimen­tation rate, C-reactive protein, HbA1c, white blood cells and troponin. RDW was higher with more severe atherosclerosis based on SYNTAX and Gensini scores (p < 0.05). Prognosis was found to be worse in patients with high RDW as well as in diabetics. Conclusions. RDW has positive correlation with other inflammatory marker. It may be used as a marker in determining the severity and prognosis in diabetic patients with coronary artery disease

Prognostic significance of serum potassium level for major adverse cardiac events and death in patients with coronary atherosclerotic disease

Introduction: Serum potassium levels have been shown in some animal studies to be associated with theprocess of atherosclerosis. We decided to assess the correlation of serum potassium level in ischemic heart diseasepatients with disease severity and its relationship with prognosis in terms of major acute cardiac events (MACE). Material and methods: This was a cross-sectional cohort study carried out at cardiology department of RehmanMedical Institute, from July 2016 to 31st Aug. 2018 a period of 26 months. 622 patients were included in thestudy. Clinical and angiographic characteristics were assessed based on the serum potassium level. Correlation ofserum potassium level with Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX) and Gensini scores was also evaluated. Follow up for MACE was carried out after one year. Results: Mean serum potassium level was 3.93 ± 0.95 (mEq/l) in coronary artery disease patients. Serumpotassium level showed negative correlation with SYNTAX score (r = –0.60, p < 0.05) and Gensini score(r = –0.64, p < 0.05). There was also a significant difference between low and high potassium level in relationto the multi-vessel disease on coronary angiography (p < 0.05). Low potassium level was a good predictor ofadverse outcomes as shown by Kaplan-Meier analysis. Multivariate Cox regression analysis showed that serumpotassium level and diabetes were independent predictors of MACE (p < 0.05). Conclusion: Low serum potassium level is correlated with more severe coronary atherosclerosis. Low potassiumlevels are associated with significantly poor outcomes

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest

The Relationship Between Gender and Ejection Fraction in Patients with Acute Coronary Syndrome after Reperfusion Therapy

Uvod: Prethodna istraživanja o povezanosti spola i ejekcijske frakcije (EF) odnosila su se samo na jednožilnu koronarnu bolest te su uzimala u obzir samo bolesnike s akutnim infarktom miokarda s elevacijom ST-segmenta (STEMI). U ovom smo radu istražili učinak spola na EF u akutnome koronarnom sindromu, uključujući STEMI i akutni infarkt miokarda bez elevacije ST-segmenta (NSTEMI) kod koronarne bolesti svih krvnih žila jer one mogu utjecati na funkciju lijeve klijetke. Bolesnici i metode: U istraživanje je bilo uključeno 480 bolesnika s akutnim koronarnim sindromom (STEMI i NSTEMI). Zabilježene su sve početne karakteristike, kao i početna EF. Svi su bolesnici bili liječeni reperfuzijskom terapijom prema međunarodnim smjernicama. Nakon praćenja od godine dana EF je izmjerena ponovno. Rezultati: Žene su bile statistički značajno starije od muškaraca (P < 0,05). Postojala je značajna razlika u EF-u između žena i muškaraca (P < 0,05). Tijekom razdoblja praćenja nije bilo značajnih promjena u EF-u u skupini žena (P > 0,05). Životna dob i ženski spol pokazali su se neovisnim prediktorima promjene EF-a. Zaključak: Ženski je spol neovisan prediktor oporavka EF-a u bolesnika s akutnim koronarnim sindromom (STEMI i NSTEMI).Introduction: Previous gender-related studies on ejection fraction (EF) were single vessel specific and considered only patients with ST-segment elevation myocardial infarction (STEMI). This study evaluated the effect of gender on EF in acute coronary syndrome, including STEMI and non-STsegment elevation myocardial infarction (NSTEMI) as well as all blood vessels, since they can affect left ventricular function. Patients and Methods: 480 patients with acute coronary syndrome (STEMI and NSTEMI) were enrolled. All baseline characteristics along with EF were noted. All patients received reperfusion therapy as per international guidelines. Patients were followed up for one year, after which EF was reassessed. Results: Women were significantly older than men (P0.05). Age and female gender were found to be independent predictors of change in EF. Conclusion: Female gender is an independent predictor of recovery of EF in patients with acute coronary syndrome (STEMI and NSTEMI)

Korelacja rozpiętości rozkładu objętości krwinek czerwonych ze wskaźnikami stanu zapalnego oraz wartość prognostyczna tego parametru u pacjentów z cukrzycą i chorobą wieńcową

Wstęp. W niedawno przeprowadzonych badaniach wykazano, że rozpiętość rozkładu objętości krwinek czerwonych (RDW) jest wskaźnikiem stopnia ciężkości choroby i rokowania u pacjentów z chorobą wieńcową. W innych badaniach skorelowano RDW z cukrzycą i stanem zapalnym. Te korelacje oraz związek z rokowaniem pozostają jednak niejasne u pacjentów z chorobą wieńcową i cukrzycą po interwencji przezskórnej. Materiał i metody. Badana grupa obejmowała 730 osób, w tym 700 chorych oraz 30 zdrowych osób (grupa kontrolna). Pacjentów z chorobą wieńcową podzielono na grupy osób z cukrzycą i bez cukrzycy. U wszystkich pacjentów zmierzono RDW przy przyjęciu do szpitala, a następnie przeprowadzono interwencję przezskórną. Obserwację w kierunku występowania zdarzeń niepożądanych prowadzono przez 6–12 miesięcy. Wyniki. Objętość krwinek czerwonych była zwiększona u osób chorych w porównaniu z grupą kontrolną (p &lt; 0,05). Parametr ten korelował dobrze ze wskaźnikami stanu zapalnego, w tym z opadaniem krwinek czerwonych, stężeniem białka C-reaktywnego, odsetkiem HbA1c, liczbą krwinek białych i stężeniem troponiny. Wartość RDW była wyższa u chorych z bardziej nasiloną miażdżycą w ocenie za pomocą skal SYNTAX i Gensiniego (p &lt; 0,05). U pacjentów z wysoką RDW, a także u chorych na cukrzycę stwierdzono gorsze rokowanie. Wnioski. Objętość krwinek czerwonych koreluje dodatnio z innymi wskaźnikami stanu zapalnego. Wskaźnik ten można wykorzystywać do określania stopnia ciężkości choroby i rokowania u pacjentów z cukrzycą i chorobą wieńcową