Salt Intake Behaviors among Type 2 Diabetic Patients of a Tertiary Level Hospital in Dhaka City

Hypertension and diabetes co-exist frequently. Therefore, salt intake behavior, a risk factor of hypertension, in diabetic patients plays an important role in determining their cardiovascular outcome. The purpose of this study was to assess the knowledge and behaviors of health risks associated with a salt intake in adults with type 2 diabetes. This cross-sectional study was conducted among the type 2 diabetic in-patients of Bangladesh Institute of Health Sciences General Hospital, Dhaka, Bangladesh from October to December 2016. Data were collected from 131 respondents through interview using WHO STEPS module of salt with adaptation to local context like on amount of added salt while taking meal. Information on blood pressure, body mass index and relevant co-morbidities were also collected. About half of the respondents were women (56.5%). Mean age of the respondents was 54.3±14.4 years. More than six in 10 of them (62.6%) took added salt while taking meal; and 40.5% took processed foods with high salt. The mean amount of added salt intake among the users was 4.4±1.6gm per day having no significant difference between men and women. Though 47.3% of the respondents believed that lowering salt in meal is very important and 77.9% of them believed that excess salt or salty sauce can cause health problems. Salt intake behavior is poor in patients with type 2 diabetes even having regular contacts with doctors and other health professionals. Appropriate measures can be taken to increase awareness, change their attitude and behavior regarding salt consumption.

Admission Troponin I and Post Thrombolytic ST-Segment Resolution in Prediction of Early Risk Stratification in ST- Elevation Myocardial Infarction

The prognostic value of admission troponin I (tnI) levels and the resolution of the ST-segment elevation in ST-elevation myocardial infarction (STEMI) is well established. However, the combination of these two early available markers for predicting the risk of early mortality has not been evaluated yet. This prospective analytical study conducted in the department of Cardiology, Sir Salimullah Medical College and Mitford Hospital, Dhaka and NICVD, Dhaka, Bangladesh from March 2004 to February 2005. We have evaluated 80 patients with streptokinase treated STEMI who had both admission troponin I and ST-monitoring. We used a prospectively defined cut-off value of troponin I of 0.1ng/ml. For ST-segment resolution, a cut-off of 50% measured after 90 minutes was used. Both a troponin I >0.1ng/ml and ST segment resolution <50% was related to higher early mortality; 16.7% vs. 14.3% (p<0.001) and 57.1% vs. 1.7% (p<0.001) respectively. In a multivariate analysis ST-segment resolution was and troponin I showed a strong trend to be independently related to early mortality. The combination of both further improved risk stratification. The early mortality in the group with elevation of troponin I and without ST-segment resolution compared to the group without troponin I elevation and with ST-segment resolution was 55.6% vs. 0%. Both troponin I on admission and ST-segment resolution after 90 minutes are strong predictors of early mortality. The combination of both gives additive early information about prognosis and further improves risk stratification.

Association between elevated B-type Natriuretic Peptide levels with extent of coronary artery disease in patients with unstable angina and NSTEMI

The study was undertaken to find out the correlation of elevated B-type Natriuretic Peptide (BNP) levels with the severity of coronary artery disease in patients with unstable angina and NSTEMI. This cross sectional analytical study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka during a period of August 2011 to June 2012. A total of 100 consecutive patients with unstable angina and NSTEMI undergoing coronary angiography were included in the study. BNP assay was done by Architect system, a chemo luminescent microparticle immunoassay (CMIA). CAG was done by conventional method within 14 days of index hospital admission. Study patients were divided into two groups on the basis of BNP levels. In Group I, BNP Levels were ≤80pg/ml and in Group II, BNP levels were elevated >80pg/ml. with 50 patients in each group. Angiographic severity of CAD was assessed by vessel score and Friesinger score. Vessel score showed single vessel was involved in 21(47.7%) patients while multi vessel in 23(52.3%) patients was found in Group I. On the contrary 11(22.4%) single vessel patients and 38(77.6%) multivessel patients were found in Group II. There was significant association between vessel involvement (p=0.01). Friesinger score revealed that less severe CAD was found in 22(44%) patients and significant severe CAD in 28(56.0%) patients in Group I. On the contrary 7(14.0%) less severe CAD patients and 43(86.0%) severe CAD patients were found in Group II. There was significant difference between severity of CAD among the study groups (p=0.01). There was linear correlation between BNP pg/ml and coronary artery disease severity in terms of Vessel score (r=0.38, p=0.01) and Friesinger score (r=0.51, p=0.01). The present study concluded that increased BNP level >80pg/ml was significantly associated with the presence and severity of CAD in patient with UA and NSTEMI.

Correlation of triglyceride level with acute coronary syndrome

The study was aimed to find out the correlation of serum triglyceride level with acute coronary syndrome. This cross sectional study was conducted in the department of cardiology, Mymensingh Medical College Hospital, from August 2009 to May 2010. Socio-demographic characteristics, smoking habit, hypertension, serum total cholesterol level, serum HDLc, Serum LDLc, TG level were important variable considered. A total number of 100 respondents consisted of 50 cases (patient) and 50 healthy persons (control). Investigations included ECG, cardiac enzyme (troponin I), FBS and lipid profile. The data were analyzed by computer with the help of SPSS. Chi-square Test, T-test & ANOVA test were used as test of significance. The mean level of TG in acute coronary syndrome (ACS) patients (cases) was 168.2±58.0 mg/dl and in control were 141.2±45.3 mg/dl. So serum TG level is significantly higher in patients with ACS (p=0.01). In multivariate regression analysis, there was a significant association of elevated TG with risk of ACS (relative risk) is the highest, compared with the lowest quarantile = 1.011; 95% confidence interval (CI = 1.002 - 1.020; P for trend = 0.01). The relation of TG level to HDLc was a strong predictor of ACS (RR in the highest) compared with lowest quarantile = 0.02; (95% CI = 0.003 - 0.173; P for trend <0.0001). The study revealed that high level of serum triglyceride is associated with ACS. Categorization of patients with ACS on the basis of TG level may be helpful for risk stratification and management.

Comparative study of coronary collaterals in diabetic and nondiabetic patients by angiography

Myocardial ischaemia is known to be significantly related to the development of coronary collaterals, but there are considerable variations in their formation. The nature of this variability is not well understood. Likewise it remains unclear whether diabetes mellitus. DM has any effect on coronary collaterals. The aim of this study was to evaluate the effect of diabetes mellitus on coronary collaterals. This prospective case- control study was done from January to December 2000 in patients undergoing coronary angiography in National Institute of Cardiovascular Diseases (NICVD), Dhaka, who fulfilled the inclusion criteria of having < or = 75% stenosis in at least one coronary artery. The patients with diabetes having CAD without other modifiable major risk factors (hypertension, smoking, dyslipidaemia) were constituted case study group (n=36) and nondiabetic patients having CAD with those risk factors were constituted control group (n=50). Coronary collaterals were graded according to Rentrope scoring system and the collateral score was calculated by summing the Rentrope number of every patient. There was no statistical difference between patients with and without diabetes in clinical characteristics. The mean number of diseased vessel in DM group 2.6+/-0.6 was higher than that in nondiabetic patients (2.1+/-0.8, P>.05). The mean collateral score was 0.5+/-0.6 in DM group and 1.2+/-1.0 in nondiabetic group. These findings suggest that coronary collateral development is significantly poorer in diabetic than on diabetic patients.

Germline mutations in the ribonuclease L gene in families showing linkage with HPC1

Although prostate cancer is the most common non-cutaneous malignancy diagnosed in men in the United States, little is known about inherited factors that influence its genetic predisposition. Here we report that germline mutations in the gene encoding 2'-5'-oligoadenylate(2-5A)-dependent RNase L (RNASEL) segregate in prostate cancer families that show linkage to the HPC1 (hereditary prostate cancer 1) region at 1q24-25 (ref. 9). We identified RNASEL by a positional cloning/candidate gene method, and show that a nonsense mutation and a mutation in an initiation codon of RNASEL segregate independently in two HPC1-linked families. Inactive RNASEL alleles are present at a low frequency in the general population. RNASEL regulates cell proliferation and apoptosis through the interferon-regulated 2-5A pathway and has been suggested to be a candidate tumor suppressor gene. We found that microdissected tumors with a germline mutation showed loss of heterozygosity and loss of RNase L protein, and that RNASEL activity was reduced in lymphoblasts from heterozyogous individuals compared with family members who were homozygous with respect to the wildtype allele. Thus, germline mutations in RNASEL may be of diagnostic value, and the 2-5A pathway might provide opportunities for developing therapies for those with prostate cancer.