IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
EVALUATING RISK OF HEART FAILURE WITH ERYTHROPOIETIN IN CHRONIC ANEMIAPARUL UNIVERSITY
Erythropoietin (EPO) is the primary regulatory hormone of
erythropoiesis. Hypoxia induces an increase in EPO hormone
production in the kidney which promotes the viability, proliferation,
and terminal differentiation of erythroid precursors, and causing an
increase in red blood cell mass. Any abnormality that reduces the renal
secretion of or bone marrow response to erythropoietin may result in
anemia. The approval of recombinant human erythropoietin
(epoetinalfa) by the US FDA in 1989, epoetinalfa and similar agents
now collectively known as erythropoietin stimulating agents (ESA)
have become the standard of care for the treatment of the
erythropoietin-deficient anemia. Studies suggest that in patients with
high serum erythropoietin is associated with risk of recurrent heart
failure (HF) and mortality. Thromboembolic complications can be
increased in patients receiving erythropoietin. the use of
erythropoiesis-stimulating agents though reduces the need for transfusions it is associated
with increased complications, including higher mortality and increased risk of
thromboembolic and cardiovascular events leading to congestive heart failure.
Electrolyte abnormalities in cardiovascular emergencies are widely studied worldwide as they are mostly found to be associated with cardiovascular morbidity and mortality. The objective of this study was to compare the serum sodium. potassium,calcium and magnesium concentrations of normal healthy individuals with first time diagnosed patients of valvular heart disease and myocardial infarction as well as to evaluate the prognostic value in the severity and outcome of valvular heart disease and myocardial infarction.Following biochemical tests, the mean serum sodium concentrations in both valvular heart disease and myocardial infarction patients were signifi cantly (p ˂ 0.05) higher than normal healthy persons. The mean potassium and calcium concentrations in valvular heart disease and myocardial patients were signifi cantly (p ˂ 0.05) high and low respectively when compared with normal healthy individuals. In comparison to normal healthy persons, respective groups of valvular heart disease and myocardial infarction patients showed a non-signifi cant (p = 0.6123) and a signifi cant (p ˂ 0.05) reduction in mean serum magnesium concentrations. Moreover, comparative analysis of mean serum electrolytes among valvular heart disease and myocardial infarction patients showed a signifi cant low sodium, high potassium, calcium and magnesium concentrations in contrast to signifi cant high sodium, low potassium, calcium and magnesium concentrations respectively.
Chronic heart disease and Anaemia. Heart failure is a very common disease, with severe morbidity and mortality, and is a frequent reason of hospitalization.
Anemia and a concurrent renal impairment are two major risk factors contributing to the severity of the outcome.
Heme iron is absorbed through a separate pathway and does not have to be discontinued when intravenous treatment is started. This can allow for longer intervals between resource-heavy, inconvenient and painful injections. Oxidative stress is also avoided.
Heme iron does not need to be discontinued during injection or EPO therapy like non-heme oral iron.
EVALUATING RISK OF HEART FAILURE WITH ERYTHROPOIETIN IN CHRONIC ANEMIAPARUL UNIVERSITY
Erythropoietin (EPO) is the primary regulatory hormone of
erythropoiesis. Hypoxia induces an increase in EPO hormone
production in the kidney which promotes the viability, proliferation,
and terminal differentiation of erythroid precursors, and causing an
increase in red blood cell mass. Any abnormality that reduces the renal
secretion of or bone marrow response to erythropoietin may result in
anemia. The approval of recombinant human erythropoietin
(epoetinalfa) by the US FDA in 1989, epoetinalfa and similar agents
now collectively known as erythropoietin stimulating agents (ESA)
have become the standard of care for the treatment of the
erythropoietin-deficient anemia. Studies suggest that in patients with
high serum erythropoietin is associated with risk of recurrent heart
failure (HF) and mortality. Thromboembolic complications can be
increased in patients receiving erythropoietin. the use of
erythropoiesis-stimulating agents though reduces the need for transfusions it is associated
with increased complications, including higher mortality and increased risk of
thromboembolic and cardiovascular events leading to congestive heart failure.
Electrolyte abnormalities in cardiovascular emergencies are widely studied worldwide as they are mostly found to be associated with cardiovascular morbidity and mortality. The objective of this study was to compare the serum sodium. potassium,calcium and magnesium concentrations of normal healthy individuals with first time diagnosed patients of valvular heart disease and myocardial infarction as well as to evaluate the prognostic value in the severity and outcome of valvular heart disease and myocardial infarction.Following biochemical tests, the mean serum sodium concentrations in both valvular heart disease and myocardial infarction patients were signifi cantly (p ˂ 0.05) higher than normal healthy persons. The mean potassium and calcium concentrations in valvular heart disease and myocardial patients were signifi cantly (p ˂ 0.05) high and low respectively when compared with normal healthy individuals. In comparison to normal healthy persons, respective groups of valvular heart disease and myocardial infarction patients showed a non-signifi cant (p = 0.6123) and a signifi cant (p ˂ 0.05) reduction in mean serum magnesium concentrations. Moreover, comparative analysis of mean serum electrolytes among valvular heart disease and myocardial infarction patients showed a signifi cant low sodium, high potassium, calcium and magnesium concentrations in contrast to signifi cant high sodium, low potassium, calcium and magnesium concentrations respectively.
Chronic heart disease and Anaemia. Heart failure is a very common disease, with severe morbidity and mortality, and is a frequent reason of hospitalization.
Anemia and a concurrent renal impairment are two major risk factors contributing to the severity of the outcome.
Heme iron is absorbed through a separate pathway and does not have to be discontinued when intravenous treatment is started. This can allow for longer intervals between resource-heavy, inconvenient and painful injections. Oxidative stress is also avoided.
Heme iron does not need to be discontinued during injection or EPO therapy like non-heme oral iron.
Systemic Hypertension (HTN) accounts for the largest amount of attributable Cardiovascular (CV) mortality worldwide. There are several factors responsible for the development of HTN and its CV complications. Multicenter trials revealed that risk factors responsible for Micro Vascular Disease (MVD) are similar for those attributable to Coronary Artery Disease (CAD) which include tobacco use, unhealthy cholesterol levels, HTN, obesity and overweight, physical inactivity, unhealthy diet, diabetes, insulin resistance, increasing age and genetic predisposition. In addition, the defective release of Nitric Oxide (NO) could be a putative candidate for HTN and MVD. This study reviewed the risk stratification of hypertensive population employing cardiac imaging modalities which are of crucial importance
in diagnosis. It further emphasized the proper used of cardiac imaging to determine patients at increased CV risk and identify the management strategy. It is now known that NO has an important effect on blood pressure, and the basal release of endothelial Nitric Oxide (eNOS) in HTN may be reduced. Although there are different forms of eNOS gene allele, there is no solid data revealing the potential role of the polymorphism of the eNOS in patients with HTN and coronary vascular diseases. In the present article, the prevalence of eNOS G298 allele in hypertensive patients with micro vascular angina will be demonstrated. This review provides an update on appropriate and justified use of non-invasive imaging tests in hypertensive patients and its important role in proper diagnosis of MVD and CAD. Second, eNOS gene allele and its relation to essential hypertension and angina pectoris are also highlighted.
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
Introduction to ncd, coronary heart disease online lecture slides 2020 april 1Animesh Jain
Non-communicable diseases and Coronary Heart Disease - Introductory lecture for MBBS students.
This is just a basic skeletal presentation to aid class taking and students' memory for recap.
ABSTRACT- Background: Microalbuminuria in hypertension has been described as an early sign of kidney damage
and a predictor for end stage renal disease and cardiovascular disease. More specifically it is seen amongst patients
suffering from hypertension.
Methods: This study was conducted at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India in the
department of emergency medicine and 84 subjects were included in the evaluation in the age of more than 30 years.
All patients were diagnosed by clinical examination, anthropometric measurement, blood pressure, urinary
microalbumin, and urinary creatinine. Statistical analysis was done by using SPSS, version 16.0 p-values were
calculated by chi-square test, ANOVA unpaired t-test. The p <0.05 was considered statistically significant.
Results: It was found that microalbuminuria among hypertensive patients increased steadily with the advancing age and
the duration of hypertension. The features of high urinary microalbumin 52.09±8.62 mg/24hr and the urinary creatinine
2.37±0.86mg/dl were prevalent in hypertensive patients and it increased in both male and female patients.
Conclusions: The prevalence of microalbuminuria in hypertensive individuals is high, and it revealed strong
association between microalbuminuria and hypertension. Our findings suggest that microalbuminuria could be a useful
marker to assess risk stratification and management of cardiovascular disease and renal disease.
Key words: Hypertension, Cardiovascular disease, Renal disease, Risk factors, Age factors, Urinary creatinine,
Urinary microalbumin
Instability and rupture of atherosclerotic plaques result in acute coronary syndrome.
LDL-C is usually related to ASCVD.
Statin medications are first-line therapy for LDL-C lowering Post ACS.
Rosuvastatin 20mg and 40 mg significantly increase HDL-C levels compared with Atorvastatin 80 mg
Cardiovascular prevention. com is a website for prevention of cardiovascular disease. In this slide presentation you can find the burden of cardiovascular disease in same Countries
Systemic Hypertension (HTN) accounts for the largest amount of attributable Cardiovascular (CV) mortality worldwide. There are several factors responsible for the development of HTN and its CV complications. Multicenter trials revealed that risk factors responsible for Micro Vascular Disease (MVD) are similar for those attributable to Coronary Artery Disease (CAD) which include tobacco use, unhealthy cholesterol levels, HTN, obesity and overweight, physical inactivity, unhealthy diet, diabetes, insulin resistance, increasing age and genetic predisposition. In addition, the defective release of Nitric Oxide (NO) could be a putative candidate for HTN and MVD. This study reviewed the risk stratification of hypertensive population employing cardiac imaging modalities which are of crucial importance
in diagnosis. It further emphasized the proper used of cardiac imaging to determine patients at increased CV risk and identify the management strategy. It is now known that NO has an important effect on blood pressure, and the basal release of endothelial Nitric Oxide (eNOS) in HTN may be reduced. Although there are different forms of eNOS gene allele, there is no solid data revealing the potential role of the polymorphism of the eNOS in patients with HTN and coronary vascular diseases. In the present article, the prevalence of eNOS G298 allele in hypertensive patients with micro vascular angina will be demonstrated. This review provides an update on appropriate and justified use of non-invasive imaging tests in hypertensive patients and its important role in proper diagnosis of MVD and CAD. Second, eNOS gene allele and its relation to essential hypertension and angina pectoris are also highlighted.
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
Introduction to ncd, coronary heart disease online lecture slides 2020 april 1Animesh Jain
Non-communicable diseases and Coronary Heart Disease - Introductory lecture for MBBS students.
This is just a basic skeletal presentation to aid class taking and students' memory for recap.
ABSTRACT- Background: Microalbuminuria in hypertension has been described as an early sign of kidney damage
and a predictor for end stage renal disease and cardiovascular disease. More specifically it is seen amongst patients
suffering from hypertension.
Methods: This study was conducted at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India in the
department of emergency medicine and 84 subjects were included in the evaluation in the age of more than 30 years.
All patients were diagnosed by clinical examination, anthropometric measurement, blood pressure, urinary
microalbumin, and urinary creatinine. Statistical analysis was done by using SPSS, version 16.0 p-values were
calculated by chi-square test, ANOVA unpaired t-test. The p <0.05 was considered statistically significant.
Results: It was found that microalbuminuria among hypertensive patients increased steadily with the advancing age and
the duration of hypertension. The features of high urinary microalbumin 52.09±8.62 mg/24hr and the urinary creatinine
2.37±0.86mg/dl were prevalent in hypertensive patients and it increased in both male and female patients.
Conclusions: The prevalence of microalbuminuria in hypertensive individuals is high, and it revealed strong
association between microalbuminuria and hypertension. Our findings suggest that microalbuminuria could be a useful
marker to assess risk stratification and management of cardiovascular disease and renal disease.
Key words: Hypertension, Cardiovascular disease, Renal disease, Risk factors, Age factors, Urinary creatinine,
Urinary microalbumin
Instability and rupture of atherosclerotic plaques result in acute coronary syndrome.
LDL-C is usually related to ASCVD.
Statin medications are first-line therapy for LDL-C lowering Post ACS.
Rosuvastatin 20mg and 40 mg significantly increase HDL-C levels compared with Atorvastatin 80 mg
Cardiovascular prevention. com is a website for prevention of cardiovascular disease. In this slide presentation you can find the burden of cardiovascular disease in same Countries
Acute heart failure: diagnosing and managing acute heart failure in adultsEmergency Live
The need for this guideline was identified as the NICE guidelines on chronic heart failure were being updated. We recognised at this time that there were important aspects of the diagnosis and management of acute heart failure that were not being addressed by the chronic heart failure guideline, which focussed on long term management rather than the immediate care of someone who is acutely unwell as a result of heart failure. The aim of this guideline is to provide guidance to the NHS on the diagnosis and management of acute heart failure.
Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. It is caused by heart muscle damage or dysfunction, valve problems, heart rhythm disturbances and other rarer causes. Acute heart failure can present as new-onset heart failure in people without known cardiac dysfunction, or as acute decompensation of chronic heart failure.
Acute heart failure is a common cause of admission to hospital (over 67,000 admissions in England and Wales per year) and is the leading cause of hospital admission in people 65 years or older in the UK.
This guideline includes important aspects of the diagnosis and management of acute heart failure that are not addressed by the NICE guideline on chronic heart failure (NICE clinical guideline 108). The guideline on chronic heart failure focused on long-term management rather than the immediate care of someone who is acutely unwell as a result of heart failure.
This guideline covers the care of adults (aged 18 years or older) who have a diagnosis of acute heart failure, have possible acute heart failure, or are being investigated for acute heart failure. It includes the following key clinical areas.
Blood Pressure Management in Cardiovascular Protection by DR Nasir Uddin.pptxNasir Sagar
High Blood pressure has multiple adverse reaction on different body system and its proper management causes beneficial effect in multiple co morbid condition.
Hemorheological indexes, living habits, medical history and genetics factor are primary risk factors in Coronary Heart Disease (CHD). In the present study the relation of all factors to the severity of CHD was examined. The data of 282 patients (mean age: 60±9 years) diagnosed with CHD and 229 healthy controls (mean age: 59±7 years) from Wenzhou Medical University were analyzed.
Perspective of Cardiac Troponin and Membrane Potential in People Living with ...asclepiuspdfs
Background: Hypertension is an event in which the force of the blood against the artery walls is too high leading to severe health complications and increases the risk of heart disease, stroke, and sometimes death. Aim: This study was carried out to determine the levels of cardiac troponin 1 and membrane potential in hypertensive subjects in Owerri, Imo state. Materials and Methods: A total of 120 subjects within the age 30–70 years were recruited for this study. The study consists of 60 subjects who were diagnosed of hypertension and 60 were apparently healthy individuals who served as controls subjects of the same age bracket. The levels of cardiac troponin 1 and membrane potential were analyzed using enzyme-linked immunosorbent assay technique. Data were assessed using SPSS version 20, the mean value with P ˂ 0.05 was considered statistically significant. Results: The result revealed that the levels of cardiac troponin 1 in hypertension were significantly increased when compared with control subjects while the levels of membrane potential were significantly decreased when compared to control at P < 0.05. Conclusion: The increased serum level of cardiac troponin 1 and decreased membrane potential in hypertensive subjects may contribute some risk factors in patients with hypertension.
Managing CV risk in Inflammatory Arthritis (Focusing on Gout)Sidney Erwin Manahan
Presentation made during the 1st Inter-Hospital Rheumatology Fellows' Case Discussion on 9 June 2018 at the Speaker Feliciano Belmonte Auditorium, 7/F East Avenue Medical Center. Presentation highlights the needs to recognize gout as one of the rheumatic conditions that put patients at risk for developing CV disease.
Evidence base for secondary prevention – Antihypertensive therapy in cerebrov...Apollo Hospitals
Antihypertensive therapy for preventing recurrence in survivors of stroke and transient ischemic attack patients requires much caution. Cutting the right balance between benefit and harm calls for the classical individual evidence based considerations. Current understanding to guide practices is briefly reviewed as stroke emerges as huge challenge with increasing longevity and chronic diseases.
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Childhood Factors that influence success in later lifeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Emotional Intelligence and Work Performance Relationship: A Study on Sales Pe...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer’s Acceptance of Internet Banking in Dubaiiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study of Employee Satisfaction relating to Job Security & Working Hours amo...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumer Perspectives on Brand Preference: A Choice Based Model Approachiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Student`S Approach towards Social Network Sitesiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Broadcast Management in Nigeria: The systems approach as an imperativeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study on Retailer’s Perception on Soya Products with Special Reference to T...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study Factors Influence on Organisation Citizenship Behaviour in Corporate ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumers’ Behaviour on Sony Xperia: A Case Study on Bangladeshiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Design of a Balanced Scorecard on Nonprofit Organizations (Study on Yayasan P...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Public Sector Reforms and Outsourcing Services in Nigeria: An Empirical Evalu...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Media Innovations and its Impact on Brand awareness & Considerationiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer experience in supermarkets and hypermarkets – A comparative studyiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Social Media and Small Businesses: A Combinational Strategic Approach under t...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Secretarial Performance and the Gender Question (A Study of Selected Tertiary...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Implementation of Quality Management principles at Zimbabwe Open University (...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Organizational Conflicts Management In Selected Organizaions In Lagos State, ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Serum uric acid as a marker of left ventricular failure in acute myocardial infarction
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 11 Ver. V (Nov. 2015), PP 102-109
www.iosrjournals.org
DOI: 10.9790/0853-14115102109 www.iosrjournals.org 102 | Page
Serum uric acid as a marker of left ventricular failure in acute
myocardial infarction
Harris P 1
, Feroz P Jenner 2
, Sunil Kumar 3
1
Clinical Assistant Professor, Department of Internal Medicine, MES Medical College & Hospital,
Perinthalmanna, Kerala
2
Clinical Associate Professor, Department of Internal Medicine, MES Medical College & Hospital,
Perinthalmanna, Kerala
3
Clinical Professor, Department of Internal Medicine, SIMS & RC, Surathkal, Karnataka, India
Abstract:Coronary Heart Disease is a worldwide health epidemic. Of particular concern from a global
perspective is the burden of myocardial infarction in developing countries. Limitations in available resources to
treat ST elevation myocardial infarction in developing countries mandate major efforts on an international level
to strengthen primary prevention programs. Elevated serum uric acid is highly predictive of mortality in
patients with heart failure or coronary artery disease. We undertook this study toknow the usefulness of serum
uric acid in acute myocardial infarction and to study the use of serum uric acid as a marker of short-term
mortality in acute myocardial infarction. A prospective study was conducted at Kasturba Medical College
Hospital, Mangalore between August 2009 & August 2011. A total of 100 cases of Acute Myocardial Infarction
were studied where 77% were males and 23% were females. 58% were hypertensives and 71% were diabetics.
We found a close relation between serum uric acid concentrations and Killip class. Serum uric acid levels were
elevated in cases of acute myocardial infarction with systemic hypertension & diabetes mellitus. Hyperuricemia
after acute myocardial infarction is an indicator of poor prognosis in acute myocardial infarction. High uric
acid concentrations on admission were strongly associated with adverse clinical outcome like mortality. Serum
uric acid can be used as a marker of short-term mortality in acute myocardial infarction.
Key Words: Serum Uric Acid, Acute Myocardial Infarction, prognostic marker.
I. Introduction:
Worldwide, 30% of all deaths can be attributed to cardiovascular disease, of which more than half are
caused by Coronary heart disease (CHD), and the forecasts for the future estimate a growing number as a
consequence of lifestyle changes in developing countries. Globally, of those dying from cardiovascular diseases,
80% are in developing countries.Of particular concern from a global perspective is the burden of myocardial
infarction in developing countries. Limitations in available resources to treat ST elevation myocardial infarction
(STEMI) in developing countries mandate major efforts on an international level to strengthen primary
prevention programs.1
There has been growing interest in the link between uric acid levels, xanthine oxidoreductase and
cardiovascular disease. A failing heart due to AMI may cause tissue hypoperfusion and hypoxia, which trigger
xanthine oxidase activation and oxidative stress production.2,3
Xanthine oxidoreductase exists in two forms,
xanthine oxidase and xanthine dehydrogenase. Both of these enzymes are responsible for metabolizing uric acid
from hypoxanthine and xanthine. Xanthine oxidase and oxidative stress as reflected by uric acid may form a
vicious cycle that promotes severe heart failure.4,2
Previous studies have reported that a high concentration of uric acid is a strong marker of an
unfavourable prognosis of moderate to severe heart failure and cardiovascular disease.4,5
Evidence suggest that
uric acid may exert a negative effect on cardiovascular disease by stimulating inflammation, which is clearly
involved in the pathogenesis of cardiovascular disease6,7
Elevated serum uric acid is highly predictive of
mortality in patients with heart failure or coronary artery disease and of cardiovascular events in patients.8
High
SUA has been indicated as a risk factor for CAD9
and as an independent prognostic factor of poorer outcomes
(occurrence of AMI, fatal AMI, sudden death, all-cause mortality) in patients with verified CAD.10
According to the Japanese Acute Coronary Syndrome Study11
, there was a close correlation between
serum uric acid concentration and Killip classification in patients of acute myocardial infarction. Elevated SUA
is also associated with hypertension and renal disease. It is present in more than 75% of patients with malignant
hypertension.12
This elevation in these settings may be the result of decreased renal blood flow and resultant
increased urate reabsorption, although this relationship is not completely understood.12
Hypertension and
prehypertension, renal disease (including reduced glomerular filtration rate and microalbuminuria), metabolic
syndrome (including abdominal obesity, hypertriglyceridemia, low level of high-density lipoprotein cholesterol,
insulin resistance, impaired glucose tolerance, elevated leptin level), obstructive sleep apnea, vascular disease
2. Serum uric acid as a marker of left ventricular failure in acute myocardial infarction
DOI: 10.9790/0853-14115102109 www.iosrjournals.org 103 | Page
(carotid, peripheral, coronary artery), stroke and vascular dementia, preeclampsia, inflammation markers (C-
reactive protein, plasminogen activator inhibitor type1, soluble intercellular adhesion molecule type 1),
endothelial dysfunction, oxidative stress, sex and race (postmenopausal women, blacks), and demographic
(movement from rural to urban communities, westernization, immigration to western cultures)are certain risk
factors associated with Elevated Uric Acid.13
The Losartan Intervention For Endpoint reduction in hypertension
(LIFE) study and Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study15
demonstrated
that lowering serum uric acid concentrations was associated with a beneficial effect on cardiovascular
outcome.14
Therefore, any drug interventions, such as therapy to decrease serum uric acid level in addition to
coronary reperfusion, may have a favourable effect on mortality in patients who have Acute Myocardial
Infarction.
We undertook this study to study the prognostic usefulness of serum uric acid in acute myocardial
infarction and to study the use of serum uric acid as a marker of short-term mortality in acute myocardial
infarction.
Objectives :
1. To study the serum uric acid levelsin Acute Myocardial Infarction,
2. To study the relation between serum uric acid levels with Killip classification suggestive of Left Heart
Failure, cardiac troponin T and CK-MB in acute myocardial infarction,
3. To study the relation between serum uric acid and systemic hypertension & diabetes mellitus in acute
myocardial infarction,
4. To study the role of serum uric acid as a marker of short-term mortality in Acute Myocardial Infarction.
II. Methodology:
A prospectivestudy was conducted at Kasturba Medical College Hospital, Mangalore between August
2010 and August 2011. All patients aged more than 18 years with ST segment elevation myocardial infarction
(STEMI) or non-ST segment elevation myocardial infarction (NSTEMI) on the basis of history, clinical
examination, ECG changes and biochemical markers and willing to participate were included into the study.
Patients with a condition known to elevate serum uric acid level (e.g. Chronic Kidney Disease, Gout,
Hematological malignancy, Hypothyroidism, Hyperparathyroidism); Patients on drugs which increase serum
uric acid (e.g. Salicylates (>2 gm/day), Ethambutol, Amiloride, Bumetanide, Chlorthalidone, Cisplatin,
Cyclophosphamide, Cyclosporine, Ethacrynic Acid, Ethambutol, Thiazide diuretics, Furosemide, Indapamide,
Isotretinoin, Ketoconazole, Levodopa, Metolazone, Pentamidine, Phencyclidine, Pyrazinamide, Theophylline,
Vincristine, Vitamin C) and chronic alcoholics were excluded. Ethics committee approval was obtained from
the Institutional Ethics Committee.
Demographic details and detailed clinical history of these cases were taken using a semi-structured
questionnaire after getting their informed written consent. Baseline investigations like Electrocardiogram,
Echocardiography, blood investigations such as Serum Uric Acid, Troponin T and CPK-MB were done on
admission. During follow up of one week, Serum Uric Acid was repeated on day 3 and day 5 of admission.
Analysis was done using SPSS. To study the prognostic usefulness of serum uric acid in acute
myocardial infarction, to correlate relation between serum uric acid and Killip classification/ hypertension/
diabetic status and to study the use of serum uric acid as a marker of short-term mortality in acute myocardial
infarction tests like t-Test, Pearson correlation and ANOVA were used.
III. Results:
A total of 100 cases of Acute Myocardial Infarction were studied where 77% were males and 23%
were females. Among the 100 study subjects, 58% were hypertensives and 71% were diabetics. The baseline
profile on the day of admission with regards to their age, mean serum uric acid level, CPK-MB, Troponin T and
Ejection Fractionare given in Table 1.
Table 1Baseline Profile on the Day of Admission of AMI Cases (N=100)
Parameter Mean + SD Minimum Maximum
Age 57.99 + 9.698 27 90
Mean Serum Uric Acid 7.84 + 2.91 4 16
Mean CK-MB 44.36 + 17.01 28 94
Mean Troponin T 0.5 + 0.51 0 3
Ejection Fraction 49.53+ 13.93 20 70
3. Serum uric acid as a marker of left ventricular failure in acute myocardial infarction
DOI: 10.9790/0853-14115102109 www.iosrjournals.org 104 | Page
Figure 1 shows the distribution of 100 acute MI cases according to Killip classification. Majority
(49%) of the cases belonged to Killip class1, followed by class2. Only 7% belonged to class 4. The distribution
of study population based on the underlying pathology has been depicted in table 2.
Table 2: Underlying pathology
Type of MI Proportion (%)
AS STEMI 19
AW STEMI 44
ExAWSTEMI 7
IW STEMI 22
IW NSTEMI 8
TOTAL 100
Figure 2 shows the serum uric acid levels of the Acute MI patients on Day 1, Day 3 and Day 5 of
admission.
The mean Serum uric acid levels on Day 1(7.84 ± 2.91), day 3 (6.48 ± 1.75) and day 5 (5.45 ± 1.16)
were found to decrease significantly (<0.001) as days passed by (Figure 2).
Table 3 shows the relation of serial serum uric acid on Day 1, Day 3 and Day 5 with gender.It was seen
that the mean serum uric acid levels of male and female MI caseswere not significantly different on the day of
admission (day 1)and Day 3. The mean serum uric acid levels on day 5 following admission was found to be
higher in male cases when compared to female cases. This difference between males and females was found to
be significant (0.001).
Table 3Relation of serial serum uric acid levels and Day 5 with gender
Uric Acid Level Sex Mean SD t value p value
Uric Acid Day 1
Female 8 2.61
0.29 0.773Male 7.79 3.00
Uric Acid Day 3
Female 5.84 1.13
1.868 0.065Male 6.65 1.85
Uric Acid Day 5
Female 4.71 0.751
3.42 0.001Male 5.66 1.18
49%
29%
15%
7%
Figure 1: Killip class
1 2 3 4
7.84
6.48
5.45
0
1
2
3
4
5
6
7
8
9
Day1 Day3 Day5
Figure 2: Mean Uric Acid Level
4. Serum uric acid as a marker of left ventricular failure in acute myocardial infarction
DOI: 10.9790/0853-14115102109 www.iosrjournals.org 105 | Page
Figure 3 shows the levels of uric acid in relation to Killip class on Day 1, Day 3 and Day 5 of
admission. The serum uric acid level was significantly higher among those cases who belonged to higher Killip
class on the day of admission (day 1), day 3 and day 5 following admission.
Figure 3Levels of uric acid in relation to Killip class
The serum uric acid levels on the day of admission were significantly higher among those patients in
higher Killip class (215.865, p <0.001). Excluding the four deaths by day 3 and the additional 2 deaths by day 5,
the serum uric acid levels were found to be significantly higher in those belonging to higher Killip class on both
day 3 (40.201, p <0.001) and Day 5(4.522, p 0.005).
Figure 4 shows the mean serum uric acid levels on Day 1, Day 3 and Day 5 among Acute MI cases
with hypertension and without hypertension.
Figure 4Mean Serum uric acid levels among Acute MI cases with hypertension
Figure 4 shows the mean serum uric acid level among the hypertensives were 8.35 + 2.56 on day1; 6.91
+ 1.52 on day 3 and 5.91 + 1.04 on day 5. The mean serum uric acid level was found to be higher among
hypertensive acute MI cases when compared with the non-hypertensiveson day 1 (2.078; p 0.04), day 3 (2.95; p
0.004) and day 5 (5.098; p <0.001) following admission.
Figure 5 shows the serum uric acid levels on Day 1, Day 3 and Day 5 among cases with diabetes
mellitus and without diabetes mellitus.
5.49 5.32 5.06
8.53
7.06
5.83
11.37
8.49
5.95
13.89
9.35
6.08
0
2
4
6
8
10
12
14
16
UA Day1 UA Day3 UA Day5
Killip 1
Killip 2
Killip 3
Killip 4
8.35
6.91
5.91
7.14
5.88
4.81
0
1
2
3
4
5
6
7
8
9
UA Day 1 UA Day 3 UA Day 5
hypetensives
non hypertensives
5. Serum uric acid as a marker of left ventricular failure in acute myocardial infarction
DOI: 10.9790/0853-14115102109 www.iosrjournals.org 106 | Page
Figure 5serum uric acid levels with diabetes mellitus
The mean serum uric acid level was found to be higher among those cases with diabetes, on day 1 (8.38
+2.92), day 3(6.85+1.74) and day 5(5.69+1.17) following admission when compared with the non-diabetics.The
mean serum uric acid level among the MI cases who were diabetic was found to be significantly higher on all
three days of follow up (t 2.995, p 0.003 on day 1; t 3.434, p 0.001 on day 3 and t 3.23, p 0.002 on day 5).
There was 6% mortality among thestudy group during the seven day follow up. There were four deaths
by day 3 and another two more deaths by day 5.Table 4 shows the between Killip class and mortality.Of the six
patients who died, none was in Killip class 1, one was in Killip class 2, two were in Killip class 3 and three were
in Killip class 4 at the time of admission. Thus, 83.3% of patients who died were in higher class i.e. class 3 and
4 at time of admission (p= 0.002).
The mean serum uric acid level on day of admission (Day 1) among those who died during the study
was 12.52 (+ 2.086) much higher than those who survived (7.54 + 2.69). There is a significant association
between serum uric acid level on admission and mortality as all the patients who died had high serum uric acid
level (t 4.431; p<0.001). Thus serum uric acid level on the day of admission can be used as a prognostic marker.
The following scatter plots are depicting relation between serum uric acid levels on day 1 and Troponin
T (Figure 6), CPK-MB (Figure 7) and Ejection Fraction (Figure 8).
Figure 6: Scatter plot depicting relation between uric acid level and Troponin T
This scatter plot shows when serum uric acid level on the day of admission was correlated with
Troponin T value, a strong positive correlation was obtained (Pearson correlation 0.840, p value <0.001), that is,
as the value of one increases the other also increases.
8.38
6.85
5.69
6.53
5.57
4.89
0
1
2
3
4
5
6
7
8
9
UA Day 1 UA day 3 UA Day 5
diabetic
non-diabetic
6. Serum uric acid as a marker of left ventricular failure in acute myocardial infarction
DOI: 10.9790/0853-14115102109 www.iosrjournals.org 107 | Page
Figure 7: Scatter plot depicting relation between uric acid level and CK-MB
This scatter plot shows that when the serum uric acid level on the day of admission was correlated with
CPK-MB values, a strong positive correlation was obtained (Pearson correlation 0.876, p value <0.001), that is,
as the value of one increases the other also increases as shown in this scatter plot.
Figure 8: Scatter plot depicting relation between uric acid level and ejection fraction
This scatter plot shows that when the serum uric acid level on the day of admission was correlated with
Ejection Fraction, a strong negative correlation was obtained (Pearson correlation - 0.916, p value 0.001), that
is, as the value of one increases the other decreases as shown in this scatter plot.
IV. Discussion:
We studied a total of 100 patients with acute myocardial infarction, of which 77 were males and 23
were females. In our study, majority (49%) of the cases belonged to Killip class 1, 29% in Killip class 2, 15% in
Killip class 3 and 7% in Killip class4.
Our study showed that hypertensive patients had more hyperuricemia and there was significant relation
between serum uric acid level (p 0.040 on day1, p 0.004 on day 3 and p<0.001 on day 5) in patients who were
7. Serum uric acid as a marker of left ventricular failure in acute myocardial infarction
DOI: 10.9790/0853-14115102109 www.iosrjournals.org 108 | Page
known or found to be hypertensive on admission. In Kojima S11
et al study it was noted that serum uric acid
concentration was significantly correlated with hypertension (r= 0.301, p value = 0.005).
71% subjects were diabetic in our study and the serum uric acid level was significantly associated with
diabetes mellitus (p= 0.003 on day 1; p= 0.001 on day 3 and p= 0.002 on day 5).
In our study patients of Killip class 3 and 4 had higher levels of uric acid as compared to patients of
class 1 and 2. (p value <0.001).Similar findings were noted by Kojima Set al11
their study. MY Nadkar, VI
Jain16
showed that serum uric acid levels are higher in patients of acute myocardial infarction correlated with
Killip class. However, VitoonJularattanapornet al17
noted that there was no observed association between
hyperuricemia and Killip class at first presentation.
We also found that there is statistically significant positive correlation (Pearson correlation 0.840,
p=0.000) between CPK-MB on day of admission and serum uric acid level on the day of admission, similarly
there is a positive correlation (Pearson correlation 0.876, p=0.000) between Troponin T levels and serum uric
acid level on the day of admission.
We noted in the present study, there was significant relation between uric acid level and mortality. High
serum uric acid levels on admission were strongly associated with adverse clinical outcome in patients who had
acute myocardial infarction.Our study showed the value of serum uric acid as a marker of short-term mortality
in acute myocardial infarction. Kojima S11
et al in their study conducted in Japan noted that hyperuricemia after
AMI is associated with the development of heart failure. However, VitoonJularattanapornet al17
noted that there
was no observed association between hyperuricemiaand in-hospital adverse outcomes. Bickel C et al reported
that one mg/dl increase in serum uric acid levels was associated with a 26% increase in mortality.18
Siniša Caret
al in their study found that higher serum uric acid determined on admission is associated with higher in-hospital
mortality and thirty-day mortality and poorer long-term survival after AMI.19
V. Conclusion:
In the present study, we found a close relation between serum uric acid concentrations and Killip
classification suggestive of left ventricular failure in acute myocardial infarction. Serum uric acid levels are
elevated in systemic hypertension, diabetes mellitus and in acute myocardial infarction. High uric acid
concentrations on admission were strongly associated with adverse clinical outcome(mortality) in patients who
had acute myocardial infarction.Hyperuricemia after acute myocardial infarction is an indicator of poor
prognosis in acute myocardial infarction. Serum uric acid can be used as a marker of short-term mortality in
acute myocardial infarction.
References:
[1]. Napoli C, Cacciatore F: Novel pathogenic insights in the primary prevention of cardiovascular disease. ProgCardiovasc Dis 2009;
51:503.
[2]. Hare JM, Johnson RJ. Uric acid predicts clinical outcomes in heart failure:insights regarding the role of xanthine oxidase and uric
acid in disease pathophysiology. Circulation 2003;107:1951–1953.
[3]. Terada LS, Guidot DM, Leff JA, Willingham IR, Hanley ME, Piermattei D, Repine JE. Hypoxia injures endothelial cells by
increasing endogenous xanthine oxidase activity. ProcNatlAcadSci USA 1992;89:3362–3366.
[4]. Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, Davos CH, Cicoira M, Shamim W, Kemp M, et al. Uric
acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation
2003;107: 1991–1997.
[5]. Leyva F, Anker S, Swan JW, Godsland IF, Wingrove CS, Chua TP, Stevenson JC, Coats AJ. Serum uric acid as an index of
impaired oxidative metabolism in chronic heart failure. Eur Heart J 1997;18: 858–865.
[6]. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;21:1685–95.
[7]. Festa A, Haffner SM. Inflammation and cardiovascular disease in patients with diabetes: lessons from the Diabetes Control and
Complications Trial. Circulation 2005;11:2414–15
[8]. Alderman M, Aiyer KJ. Uric acid: role in cardiovascular disease and effects of losartan. Curr Med Res Opin 2004;20:369-79.
[9]. Allison TG. Coronary heart disease epidemiology. In: Murphy JG,LloydMA, editors. Mayo clinic cardiology. 3rd edition.
Rochester(MN): Mayo Clinic Scientific Press; 2007. p. 687-93.
[10]. Brodov Y, Chouraqui P, Goldenberg I, Boyko V, Mandelzweig L, Behar S. Serum uric acid for risk stratification of patients with
coronary artery disease.Cardiology.009;114:300-5.
[11]. Kojima S, Sakamoto T, Ishihara M, et al. Prognostic usefulness of serum uric acid after acute myocardial infarction (Japanese Acute
Coronary Syndrome Study). Am J Cardiol 2005;96:489-95.
[12]. Johnson RJ, KD, Feig D, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease?
Hypertension. 2003;41:1183–1190..
[13]. Daniel I. Feig, Duk-Hee Kang, Richard J. Johnson. Uric Acid and Cardiovascular Risk. N Engl J Med 359;17
[14]. Hoieggen A, Alderman MH, Kjeldsen SE, Julius S, Devereux RB, De Faire U, Fyhrquist F, Ibsen H, Kristianson K, Lederballe-
Pedersen O,et al, for the LIFE Study Group. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney
Int 2004;65:1041–1049.
[15]. Athyros VG, Elisaf M, Papageorgiou AA, Symeonidis AN, Pehlivanidis AN, Bouloukos VI, Milionis HJ, Mikhailidis DP, for the
GREACE Study Collaborative Group. Effect of statins versus untreated dyslipidemia on serum uric acid levels in patients with
coronary heart disease: a subgroup analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study.
Am J Kidney Dis 2004;43:589–599.
[16]. MY Nadkar, VI Jain. Serum Uric Acid in Acute Myocardial Infarction. J Assoc Physicians India.2008 Oct;56:759-62.
8. Serum uric acid as a marker of left ventricular failure in acute myocardial infarction
DOI: 10.9790/0853-14115102109 www.iosrjournals.org 109 | Page
[17]. VitoonJularattanaporn, RungrojKrittayaphong, ThananyaBoonyasirinant, KamolUdol, SuthipolUdompunurak.Prevalence of
Hyperuricemia in Thai Patients with Acute Coronary Syndrome. Thai Heart J 2008; 21:86-92.
[18]. Bickel C, Rupprecht HJ, Blankenberg S, et al. Serum uric acid as an independent predictor of mortality in patients with
angiographically proven coronary artery disease. Am J Cardiol 2002;89:12-7.
[19]. Siniša Car, Vladimir Trkulja. Higher serum uric acid on admission is associated with higher short-term mortality and poorer long-
term survival after myocardial infarction:retrospective prognostic study.Croat Med J. 2009; 50: 559-66