Journal of Enam Medical College; Vol 3 No 2 July 2013; Page 60-62 DOI: http://dx.doi.org/10.3329/jemc.v3i2.16124

No abstract

Medicine Today 2011 Volume 23 Number 01 Page 60-62 DOI: http://dx.doi.org/10.3329/medtoday.v23i1.11950

Acute Coronary syndrome (ACS) is the most common cause of admission to the coronary care unit with highest risk of death and adverse outcomes. ACS accounts for 60-70% of all admissions in the hospital. Patients with ACS encompass a heterogeneous group that varies widely regarding severity of the underlying coronary artery disease, prognosis and response to treatment. Patients with the highest risk of subsequent events usually have the largest benefit of an intensified pharmacological treatment and early mechanical intervention. The prognosis for low-risk patients, on the other hand, is often difficult to improve further and these patients usually benefit more from a conservative management with a lower risk of side effects. Therefore, risk stratification is essential and should be initiated early and updated continuously throughout the hospital stay. Early risk stratification is usually performed by the use of clinical background factors, clinical presentation, electrocardiography and biochemical markers of myocardial damage. Levels of natriuretic peptides have been shown to reflect cardiac performance. The aim of this study was to review elaborately on B type Natriuretic Peptide (BNP) and its prognostic value in patient with ACS. This review focuses on the emerging role of these peptides in the early risk stratification of ACS patients. Elevation of BNP levels in acute MI and UA is predictive of a greater risk of death, post infarction heart failure, or reinfarction. Post infarction studies demonstrate that elevated plasma BNP levels are associated with larger infarct size, increased probability of ventricular remodeling, lower ejection fraction, higher risk of heart failure, and increased mortality. This cardiac marker is a potent predictor of mortality in patients with all forms ACS. BNP measurements serve as an index of severity of the ischemic injury, as well as the degree of impairment in left ventricular function.

Background: There are an increasing number of hospital admissions due to heart failure with diabetes or prediabetes in different hospitals in Bangladesh. But very little is known about the frequency of diabetes and prediabetes and the effect of its presence on the characteristics and outcome in patients hospitalized for heart failure. The objective of this study was to find out the frequency of diabetes and prediabetes in heart failure patients and to assess their association with in-hospital outcome. Methods: This cross sectional analytical study was done in the department of Biochemistry and Cardiology of Bangabandhu Sheikh Mujib Medical University in collaboration with department of Cardiology of National Institute of Cardiovascular Diseases, and Dhaka Medical College Hospital from July 2010 to June 2011. After proper ethical consideration a total two hundred and fifty heart failure patients were enrolled in the study by nonrandom sampling. Fasting blood sugar was done in all patients and oral glucose tolerance test was done in patients with impaired fasting glycaemia. Results: The frequency of prediabetes among the total population was 12.8% (95% CI,) and that of diabetes was 37.2% (95% CI, 31.2-43.2%). Improvement was achieved in 27 (84.4%) cases in prediabetic group, 75 (80.6%) cases in diabetic group and 105 (84.0%) cases in nondiabetic group. Mortality rates in prediabetes, diabetes and nondiabetes were 5 (15.6%); 18 (19.4%) and 20 (16.0%) respectively. The differences found among the three groups were not statistically significant (p>0.05). Length of hospital stay was also similar in all groups of study subjects. Conclusion: Frequency of diabetes among heart failure patients is high and pre-diabetes is not negligible in our country. Future studies in this field should focus on all types of glucose abnormalities rather than previously diagnosed diabetes only.

Continuing professional development is the process of life-long learning in practice. It helps the medical professionals to keep them up-to-date to meet the needs of the patient and health care services and to improve their knowledge, skill and attitude.Enam Medical College arranges CPD programmes regularly. During the period of January to June 2013, total 22 seminars were held. Around 300 students, doctors and teachers attended each of these seminars.