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Background: The diagnosis and management of acute coronary syndrome (ACS) have improved significantly over the past few decades; however, the recognition of myocardial ischemia still proves to be a dilemma for cardiologists. The aim of this study was to determine the role of hematological and coagulation parameters in the diagnosis and prognosis of patients with ACS. Methods: This prospective study recruited 250 patients with ACS and 250 healthy controls. The diagnostic role of hematological and coagulation parameters was assessed by comparing the patients with ACS with the control group. The relationships between these parameters and mortality were determined by dividing the patients into 2 groups: Group A (discharged) and Group B (patients who died within 30 days of follow-up). Multivariate Cox regression analysis was performed to calculate the hazard ratio (HR). Results: The mean age of the patients was 55.14±10.71 years, and 65.2% of them were male.  Prothrombin time (P<0.001), activated partial thromboplastin time (P<0.001), mean platelet volume (MPV) (P<0.001), white blood cell (WBC) count (P<0.001), and red blood cell distribution width (RDW) (P<0.001) were significantly higher in the case group than in the control group. WBC count (P<0.001), RDW (P<0.001), and MPV (P<0.001) were significantly higher in the controls than in the case group. The Cox regression model showed that RDW above 16.55% (HR=6.8), MPV greater than 11.25 fL (HR=2.6), and WBC higher than 10.55×103/μL (HR=6.3) were the independent predictors of mortality. Conclusion: In addition to being the independent predictors of short-term mortality, RDW, WBC, and MPV when used together with the coagulation profile may aid in the diagnosis of ACS in patients presenting with chest pain.

BackgroundSelf-monitoring of blood glucose (SMBG) is a critical component of diabetes care. However, it has been shown that use of glucometers in developing countries such as Pakistan is limited. The aim of this study was to determine the frequency of glucometer usage in the urban diabetic population of Karachi and to identify variables that influenced the likelihood of practice of SMBG.MethodsA cross-sectional study was conducted among 567 adult diabetic patients selected at random from the out-patient departments of multiple healthcare institutions in Karachi categorized into two settings; Government and Private. Non-diabetics, patients having gestational diabetes, diabetes insipidus and Cushing’s syndrome and terminally ill patients were excluded. Pearson Chi-square and Mann-Whitney U test were applied as the primary statistical method.ResultsPrevalence of home glucometer usage was 59% (n= 331). High socioeconomic status (p < 0.001), receiving care from private institutions (p < 0.001), higher education (p < 0.001), a family history of diabetes (p =0.001), awareness regarding diabetes (p < 0.001), having diabetes for > five years (p <0.001), and managing diabetes via pharmacological interventions (p <0.001) (versus diet and exercise) were significant positive predictors of glucometer usage. ConclusionsOur study demonstrates the increasing trend in use of SMBG. Lack of awareness and cost of glucometers were reported to be the main reasons for not practicing SMBG. Given these factors are easily modifiable, government subsidized initiatives and awareness programs can result in a successful public health strategy to promote SMBG.

WMR is an easily accessible and an inexpensive indicator, which may be used as a prognostic marker in patients with ACS.

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