Frequency of Hyperuricemia in Subjects With Unstable Angina/Myocardial Infarction and Their Prognosis

Abstract


 Background: Inhibition of nitric oxide synthesis and stimulation of smooth muscle proliferation by increased serum levels of uric acid play an important role in accelerated atherogenesis in the vessels of patients with hyperuricemia. The objective of the study was to determine the frequency of hyperuricemia in patients with acute coronary syndrome and their in-hospital outcomes.
 Methods: This cross-sectional study was conducted in the cardiology department of Ayub Teaching Hospital, Abbottabad from ­­­­­­­­­­­­­­­­­­­1st September, 2018 to 28th February, 2019. A total of 199 patients diagnosed with acute coronary syndrome (ACS) were enrolled in this study using non-probability consecutive sampling. Diagnosis of ACS was made on history, electrocardiogram (ECG) findings and on the presence of elevated cardiac biomarkers. Serum uric acid was checked within 24 hours of presentation and patients were grouped into hyperuricemic and normouricemic groups according to uric acid levels. Next in-hospital outcomes were compared between the two groups by comparing the presence or absence of complications. The data was collected on a structured proforma and was analyzed statistically by using SPSS version 16.
 Results: Out of 199 patients, 146 (73.37%) were male and 53 (26.63%) were female. The mean age of the study participants was 57.99 ± 6.07 years with a range of 48-68 years. Hyperuricemia was diagnosed in 50 (25.13%) study participants. Among complications, 15 patients (7.94%) had cardiogenic shock, 27 (13.57%) had heart failure, 10 (5.03%) had cardiac arrhythmias, 16 (8.04%) had conduction defects and hyperuricemia was diagnosed in 50 (25.13%) patients. Cardiogenic shock was more common in patients with hyperuricemia (p < 0.05).
 Conclusion: Hyperuricemia is associated with a number of significant adverse outcomes for patients with an acute coronary event. Regular screening / monitoring of serum uric acid level in general population can prevent the direct and indirect morbidity associated with hyperuricemia.
 Keywords: Acute coronary Syndrome, Hyperuricemia, Uric Acid, cardiogenic shock, mortality, ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS)

Validity of Pediatric Index of Mortality 2 score as an Outcome Predictor in Pediatric ICU of a Public Sector Tertiary Care Hospital in Pakistan

“…We observed mortality of 29.9% in our ICU population which was similar to some other ICUs of developing countries like India (30% in 2007, 46.2% in 2011, 28% in 2014, and 34% in 2018) 4 13 14 15 and Pakistan (28.7% in 2007), 7 albeit higher than ICUs of the western world with greater medical personnel, nursing staff, and specialized equipment. The expected mortality computed by PIM-2 score was 27.9% giving an SMR of 1.07 (95% CI: 0.79–1.41), which was almost equal to 1 but showed that PIM-2 score just slightly underpredicted mortality which was quite contrary to well-established centers which depicted overprediction by the model with SMR <1.…”

“…3 However, most of the well-developed centers had higher values of AUC including 0.9 from Australia and New Zealand 10 and 0.87 from Spain. 19 A previous study done in Lahore, Pakistan reported an AUC of 0.88 with a good calibration of the model, 7 as it was done in an ICU with a higher influx of cardiac and postsurgical patients and patient to nurse ratio of 1:1.…”

“…10 13 16 Most of the developing countries have reported an SMR above 1, 2 15 suggesting under prediction by the model including one study in Pakistan which reported an SMR of 1.47. 7…”

“…4 5 However, reports about implementation and outcome of these scoring systems are limited from Pakistan, such as the one from Qureshi et al done in 2007. 7 A few centers, however, have reported poor results and thus calibrated the scores according to their population characteristics. A study from India showed a lower sensitivity of 70.6% for PIM-2.…”

Frequency of Diabetic Retinopathy Amongst Type 2 Diabetes Mellitus Patients

“…A study carried out by M A Shaikh et al reported 25.5% prevalence of diabetic retinopathy amongst type 2 diabetes mellitus patients which is not in accordance with our study but they reported comparable frequency of Background retinopathy, Preproliferative retinopathy and Proliferative retinopathy by classifying cases of diabetic retinopathy 19 . A previous randomized control study reported 40.1% diabetic retinopathy prevalence amongst type 2 diabetes mellitus patients whic is almost same with our study findings 20 .…”