Inflammation, oxidative stress, and high concentration of serum lipoprotein (a) [Lp (a)] are common complications in hemodialysis patients. The present study was designed to investigate the effects of L-carnitine supplement on serum inflammatory cytokines, C-reactive protein (CRP), Lp (a), and oxidative stress in hemodialysis patients with Lp (a) hyperlipoproteinemia [hyper Lp (a)]. This was an unblinded, randomized clinical trial. Thirty-six hyper Lp (a) hemodialysis patients (23 men and 13 women) were randomly assigned to either a carnitine or control group. Patients in the carnitine group received 1000 mg/d oral L-carnitine for 12 weeks, whereas patients in the control group did not receive any L-carnitine supplement. At baseline and the end of week 12, 5 mL of blood were collected after a 12- to 14-hours fast and serum free carnitine, CRP, interleukin-1β, interleukin-6 (IL-6), tumor necrosis factor-α, Lp (a), and oxidized low-density lipoprotein were measured. Serum free carnitine concentration increased significantly by 86% in the carnitine group at the end of week 12 compared with baseline (P<0.001), while serum CRP and IL-6 showed a significant decrease of 29% (P<0.05) and 61% (P<0.001), respectively. No significant changes were observed in serum free carnitine, CRP, and IL-6 in the control group. There were no significant differences between the two groups in mean changes of serum interleukin-1β, tumor necrosis factor-α, Lp (a), and oxidized low-density lipoprotein concentrations. L-carnitine supplement reduces inflammation in hemodialysis patients, but has no effect on hyper Lp (a) and oxidative stress.
AimsWe aimed to compare the GRACE and TIMI risk scores in patients with non- ST elevation acute coronary syndrome for their accuracy in predicting the angiographic severity of coronary artery disease.MethodThe cross-sectional study done in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from April, 2015–April, 2016. The patients admitted with non-ST elevation acute coronary syndrome were evaluated to calculate the GRACE and TIMI risk score. Coronary angiogram was done during index hospitalization and the severity of coronary artery disease was assessed by vessel score and Gensini score.ResultsOf 205 patients, a positive correlation of the vessel score and Gensini score was observed with both the GRACE and TIMI risk scores (p = <0.001) and the GRACE score (r = 0.55) correlated better than the TIMI score (r = 0.51). The GRACE score presented area under the Receiver Operating Characteristic (ROC) curve (0.943; 95% CI = 0.893–0.993) significantly superior to the area under the ROC curve (0.892; 95% CI = 0.853–0.937) of the TIMI score.ConclusionBoth the GRACE and TIMI risk scores had good predictive value in assessment the severity of coronary artery disease in patients with non-ST elevation acute coronary syndrome, when they were compared, the GRACE score was found to be superior to the TIMI score.
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