Study of Serum Uric Acid levels in patients with Acute Myocardial Infarction and Its correlation with the severity assessed by Killip Classification and 2D Echocardiogram

BACKGROUND : Cardiovascular disease especially coronary artery disease is a part of major disease burden pan India. Coronary artery disease has attained epidemic proportions in India. In a developing country like India, for patients with acute Myocardial Infarction, a simple, cheap and easily available serum marker like uric acid could be an excellent tool in predicting the prognosis and long term management strategies. Our study was aimed at establishing a relationship between the levels of serum uric acid in various types of acute myocardial infarction and correlation of its levels with the degree of myocardial dysfunction as assessed by echocardiogram and the Killip, GRACE and TIMI scores. MATERIALS AND METHODS : it was prospective observational study conducted at Government Mohan Kumaramangalam Medical College Hospital during July 2015 to January 2016. 100 consecutive patients admitted to the Medical ICU, Coronary care unit and medical wards were evaluated with detailed history, examination and laboratory investigations. Serum uric acid levels were assessed on day 0 and day 3 of admission. Patients were followed up for a period of 7 – 15 days or discharge whichever was earlier to assess the major in hospital adverse cardiac events. RESULTS : In our study, the proportion of Hyperuricemics in acute MI was found to be 59%. 55 cases were STEMI and 45 cases were NSTEMI. 74.5% of STEMI had Hyperuricemia whereas it was only 40% in NSTEMI (p value 9mg/dl was observed in 100% (n=9) of the patients who succumbed to death. 24 per cent of the patients in study population had serum uric acid levels more than 9 mg/dl and 91.96% of this group belonged to Killip classes III and IV. The mean SUA levels in Killip classes III and IV were 9.72mg and 12.46 mg/dl respectively as compared to 5.68mg/dl and 7.36 mg/dl in Killip classes I and II (p value 0.0005). Statistically significant positive association was found between Hyperuricemia and Smoking (p value 0.003), Hypertension (p value 0.001) and Heart blocks (p value 0.003). No significant association was observed between and serum uric acid levels and diabetes mellitus (p value 0.119) nor with dyslipidemia (p value 0.508). The mean TIMI score in general was higher in hyperuricemic patients in both STEMI (7.56±2.5 vs 5.64±2.3) and NSTEMI (4.89±0.9 vs 3.89±0.8). The mean risk of in-hospital mortality in patients with hyperuricemic patients was 9.44% higher as compared to normouricemic patients (p value 0.0005). 100 percent (n=16) of the patients with serum uric acid > 9mg/dl had ejection fraction less than 30%. CONCLUSION : Serum uric acid levels were elevated in patients with acute myocardial infarction. There is a strong correlation between serum uric acid at the time of admission and in-hospital mortality and short term mortality in patients with acute myocardial infarction. Serum uric acid levels in a patient with acute myocardial infarction can be used as an independent predictor of mortality and morbidity in the form of major adverse cardiac events. Serum uric acid levels has a statistically significant linear relationship with TIMI and GRACE scores. Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction

‘River! that in silence windest’ The place of religion and spirituality in social work assessment: sociological reflections and practical implications

This paper explores the place of religion and spirituality in social work assessment. Place represents a topographic or locational concept that suggests an embeddedness within a physically bounded space, implying here that religion and spirituality are centrally important to the lives of many people and therefore necessarily part of the social work relationship between practitioners and their clients or service users. A range of concepts and implications arising from the idea that religion and spirituality form a necessary part of quotidian social work practice require some discussion. First of all we must recognize that religion and spirituality are often seen as synonyms and we must first discuss this and suggest discrete definitions of each concept. We also need to discuss assessment itself in social work, recognising the power relations and potential for the normative imposition of unspoken and taken-for-granted assumptions in making judgements about vulnerable people’s ecologies and psychologies. This is problematised further when we consider questions of vulnerability – a contested term in itself; who makes someone vulnerable, is it a quality or characteristic or does it reflect something structural, or both? Social work may be considered as a locally contextualized set of processes or moral practices that make statements about assumed vulnerabilities. We are taking this further by asking about religion and spirituality as one aspect of this collection of processes. This may project social work as both homogeneous, transferable and globally understood, an idea we will need to debate. Accepting that all these concepts may be contested and problematic we can move forward to consider ways in which religion and spirituality may be assessed in social work, making reference predominantly to UK and US social work whilst being tentative in making any normative assumptions about this exploration. A number of models will be introduced, drawing out some of the potential meanings and consequences of these for interpersonal relationship and also for people’s spiritual perspectives. A case example of the exclusion of religion and spirituality, notably Christianity, from UK social work in the recent past will be provided. This background prepares us for moving towards a sociological analysis of the state of play

Doing Public Sociology: Student perspectives of international placements

Here nine Bournemouth University undergraduate sociology students reflect on the international placements they undertook in January 2016 in welfare settings in Penang, Malaysia under the auspices of our partner, Universiti Sains Malaysia (USM). Placed in selected NGOs working at the ‘coalface’ of need, the agencies gave aptitude-testing demands of the students to rapidly adjust and cope with very different work expectations in an unfamiliar socio-cultural context, as described below

A cell attracting composite of lumbar fusion cage

Lumbar fusion cages are devices used in spinal fusion procedures for disorders such as spondylosis and degenerative disc diseases that may occur due to age, trauma or genetic reasons. These devices are most frequently made of metals and polymers. The mechanical properties of such devices should be comparable to the bone to avoid stress shielding. Besides, cages should interact with the cells to prevent extrusion and achieve satisfactory fusion. In this study, poly(methylmethacrylate) (PMMA) and hydroxyapatite (HAp) were compounded to create products with HAp contents up to 40% (w/w), processed by hot melt extrusion and injection molded to produce composites with maximum polymer-mineral interaction. The morphology, interaction with the plates and rate of proliferation of human osteoblast-like (HOB) cells were studied in vitro. We learned that cells interact more with HAp when the HAp content is higher than 20%. Tensile and compressive properties of PMMA were significantly increased with increasing HAp content; from an elastic modulus (E) of 2.08 to 3.92GPa in tension, and from 349 to 562MPa in compression. High HAp content of the samples increased the roughness from 0.69m for pure PMMA to 1.35m for 40% (w/w) HAp loaded PMMA, increased cell proliferation and as a result the cells presented filopodia indicating a satisfactory level of interaction with the cage surface. Based on mechanical and in vitro studies, a HAp content of around 30% (w/w) was found to be appropriate for good cell adhesion and satisfactory mechanical properties for use in the construction of a fusion cage. It was concluded that when PMMA and HAp were compounded at an optimal value, a cage material with adequate mechanical properties and increased cell attachment can be obtained for use in spinal fusion applications

PCL and PCL-based materials in biomedical applications

Biodegradable polymers have met with an increasing demand in medical usage over the last decades. One of such polymers is poly(epsilon-caprolactone) (PCL), which is a polyester that has been widely used in tissue engineering field for its availability, relatively inexpensive price and suitability for modification. Its chemical and biological properties, physicochemical state, degradability and mechanical strength can be adjusted, and therefore, it can be used under harsh mechanical, physical and chemical conditions without significant loss of its properties. Degradation time of PCL is quite long, thus it is used mainly in the replacement of hard tissues in the body where healing also takes an extended period of time. It is also used at load-bearing tissues of the body by enhancing its stiffness. However, due to its tailorability, use of PCL is not restricted to one type of tissue and it can be extended to engineering of soft tissues by decreasing its molecular weight and degradation time. This review outlines the basic properties of PCL, its composites, blends and copolymers. We report on various techniques for the production of different forms, and provide examples of medical applications such as tissue engineering and drug delivery systems covering the studies performed in the last decades