A STUDY OF PREVALENCE OF CHRONIC KIDNEY DISEASE IN ACUTE CORONARY SYNDROME AND ITS IMPACT ON THE MANAGEMENT AND OUTCOME IN ACUTE CORONARY SYNDROME PATIENTS

Background and Objectives: Acute coronary syndromes (ACS) are common in Chronic Kidney Disease and are major source of short term and long term morbidity and mortality in this population. CKD represents a potent and independent risk factor for adverse outcome in ACS patients. Management of patients with CKD presenting with ACS is more complex than in thegeneral population because of the lack of well-designed Randomized trials assessing the rapeutic strategies in such patients. Among ACS patients, Chronic Kidney Disease doubles the death rates and is third only to Cardiogenic Shock and Congestive Heart Failure as apredict or of Mortality. As there is need for improved representation of patients with CKD in Randomized clinical trialsto characterise risks and benefits of medical therapies in ACS patients so as to increase Evidencebased decisions. There are limited data on the prevalence of CKD in Acute Coronary Syndromepatients in Indian population. Hence, this Study was done to determine the prevalence of CKD in ACS patients and find the Management difference in Acute Coronary Syndrome patients with CKD and without CKD and todeterminethe outcome of patientswith CKD. Methods: 150 cases of ACS admitted at a Tertiary Care Hospital meeting the inclusion criteria wereconsidered in 1 year time period. Its a single centred, time bound and prospective study. Patients with Acute Coronary Syndrom eare selected randomly from Cardiology IPD sections and screened. For Serum Creatinine&Urine foralbumin and other relevantinvestigations. Thefollowing investigations were done/Data was collected in the selected patients by using prestructured questionnaire. Data was entered into Microsoft excel data sheet and was analyzedusing SPSS 22version software. Categorical datawas represented in the form of Frequencie sand proportions.Chi-square test was use dastest of significance for qualitative data Continuous data was represented as mean and standard deviation. Independent t test was use dastest of significance to identify the mean difference between two quantitative variables. Results: Inthestudy prevalence of CKD among ACS subjects was 35.3%.FemaleACSsubjects had highest incidence of CKD compared to Males. Among subjects with NSTE-ACS,44.2% had CKD and among Subjects with STEMI, 26% had CKD. Mean EF among CKD subjects was 41.40 ± 7.11% and among those without CKD was 46.06 ± 8.40%. Among CKD subjects17%had mortality and among non CKD subjects 2.1%had mortality. The rewash significant association between mortality and CKD. Interpretation and Conclusion: From the study it was concluded that Prevalence of CKD among ACS subjects was high. With advancemen to fage there was increase inincidence of CKD and female predominance was observed. Co-morbidities such as DM and HTN increases the prevalence of CKD in ACS subjects. NSTEMI had higher incidence of CKD compared toSTEMI. Adequate Medical management and PTCA + Stent improved the outcome among ACS subjects.Mortalitywashigher amongCKDsubjectscompared toNon CKDsubjects.

Impact of COVID-19 Pandemic on Acute Coronary Syndrom/NSTEMI Admission rates and Quality of Service in Ibrahim Bin Hamad Obid Alla Hospital – Ras Al-Khaimah, UAE (IBHOH-RAK)

Aim: Study the impact of COVID -19 pandemic on the numbers of patients attended & admitted with ACS/NSTEMI and quality of service comparing the non-COVID -19 and COVID -19 era (for the same period of the year. Materials and Methods: The data collected retrospectively of the patients were admitted and diagnosed with ACS/NSTEMI. Results: The total numbers of patient were diagnosed as ACS/NSTEMI in 6 months period (COVID -19 era) and are evaluated by Echocardiography before discharge. Conclusion: The quality of services and the number of patients admitted in the hospital were same as of previous years.

Psikoterapi Individu sebagai Mediasi Ansietas pada Kegawatan Kasus Psikososial Pasien Acute Coronary Syndrome

Acute Coronary Syndrom atau ACS merupakan salah satu penyakit kardiovaskuler, Prognosis fisiologis dari penyakit ACS ini dipengaruhi faktor psikososial diantaranya kecemasan. Proses perawatan di ruang rawat intensif berdampak pada kedinamisan kondisi sakit pasien, sehingga dibutuhkan suatu bentuk psikoterapi yang dapat mengatasi kegawatan psikososial untuk menjaga stabilitas tanda-tanda klinis pasien. Data primer yang diperoleh dari Rumah Sakit Muhammadiyah Se-Kabupaten Kebumen menunjukan dalam waktu 1 bulan terakhir sebanyak 50 pasien ACS mengalami ansietas. Penelitian ini bertujuan penelitian untuk Mengetahui tingkat ansietas pasien ACS sebelum dan sesudah diberikan psikoterapi individu di RS Muhammadiyah Se-Kabupaten Kebumen. Metode penelitian ini menggunakan quasi experimental designs dengan pendekatan pre and post test without control group, sampel yang digunakan sebanyak 20 responden pasien ACS menggunakan teknik simple random sampling, Analisa data menggunakan uji t-test, Instrumen pengukuran ansietas menggunakan HADS. Hasil penelitian menunjukan tingkat ansietas pasien sebelum diberikan psikoterapi individu mengalami tingkat ansietas berat , setelah diberikan psikoterapi individu pasien mengalami tingkat ansietas normal, ini berarti ada perbedaan tingkat ansietas yang bermakna antara sebelum dan sesudah diberikan psikoterapi individu dengan nilai P value 0,000 (Pvalue ≤ 0,05). Kata kunci: acute coronary syndrom, psikoterapi individu, ansietas INDIVIDUAL PSYCHOTHERAPY AS ANXIETY MEDIATION IN PSYCHOSOCIAL EMERGENCY CASE IN ACUTE CORONARY SYNDROME ABSTRACTAcute Coronary Syndrome or ACS is a cardiovascular disease. The physiological prognosis of ACS is influenced by psychosocial factors including anxiety. The process of treatment on ACS patients in the intensive care unit has several impacts on the dynamic condition of the patient's illness, therefore the kind of psychotherapy is needed to overcome psychosocial emergency case to maintain the stability of the patient's clinical signs. Primary data obtained from Muhammadiyah Hospitals in Kebumen Regency showed that in the last 1 month as many as 50 ACS patients experienced an anxiety. This study aimed to determine the level of anxiety of ACS patients before and after individual psychotherapy given at Muhammadiyah Hospital in Kebumen Regency. This research method used quasi experimental designs with pre and post-test approach without control group, the sample of this study was 20 respondents of ACS patients using simple random sampling technique, data analysis used t-test, Instrument for Anxiety Used HADS. The results showed the anxiety level of patients before giving individual psychotherapy experienced high anxiety levels, meanwhile patients experienced normal anxiety levels after giving individual psychotherapy. It means, there was significant differences on anxiety level between before and after being given individual psychotherapy with p-value 0,000. Keywords: acute coronary syndrome, individual psychotherapy, anxiety

Predictive Value of Hematologic Indices in the Diagnosis of Acute Coronary Syndrome

BACKGROUND: Distinguishing between Acute Coronary Syndrom (ACS) and SCAD (Stable Coronary Artery Disease) requires advanced laboratory instrument and electrocardiogram. However, their availabilities in primary care settings in developing countries are limited. Hematologic changes usually occur in the ACS patient and might be valuable to distinguish ACS from SCAD. AIM: This study compares the hematologic indices between ACS and SCAD patients and analyses its predictive value for ACS. MATERIAL AND METHODS: A total of 191 patients (79 ACS and 112 SCAD) were enrolled in this study based on the inclusion criteria. Patient’s characteristic, hematologic indices on admission, and the final diagnosis were obtained from medical records. Statistical analyses were done using SPSS 23.0. RESULTS: In this research MCHC value (33.40 vs. 32.80 g/dL; p < 0.05); WBC (11.16 vs. 7.40 x109/L; p < 0.001); NLR (6.29 vs. 2.18; p < 0.001); and PLR (173.88 vs 122.46; p < 0.001) were significantly higher in ACS compared to SCAD patients. While MPV (6.40 vs. 10.00 fL; p < 0.001) was significantly lower in ACS patients. ROC curve analysis showed MPV had the highest AUC (95%) for ACS diagnosis with an optimum cut-off point at ≤ 8.35 fL (sensitivity 93.6% and specificity 97.3%). CONCLUSION: There was a significant difference between hematologic indices between ACS and SCAD patients. MPV is the best indices to distinguish ACS.

PERBEDAAN KADAR PROLYLCARBOXYPEPTIDASE DI PASIEN SINDROM KORONER AKUT DENGAN PASIEN ANGINA STABIL (The Difference of Prolylcarboxypeptidase Level in Acute Coronary Syndrom and Stable Angina Patient)

Coronary arterial disease (CAD) is the main cause of mortality across many countries throughout the world. Formation ofatherosclerosis plaque is the early cause for cardiovascular dysfunction in CAD. Detecting of atherosclerosis plaque instability is veryimportant to predict the risk of acute coronary syndrome (ACS). Various biomarkers have been studied to find the good marker fordetecting atherosclerosis and its instability, but until now there is no biomarker meet the requirements to be used in routine clinicaltests. Prolylcarboxypeptidase (PRCP) is the alternative parameter in the detection of atherosclerosis, assessing the degree of its plaqueand instability in CAD patients. The benefits of PRCP level test in serum, compared to angiography that is currently used in the detectionof atherosclerosis plaque is that this test is non-invasive, provides quantitative level information, able to estimate the instability of theplaque and the fact that it is a laboratorial test that can be performed in hospitals with less advance facilities. The aim of this study isto know the different PRCP level between ACS and stable angina patients by determination. This study was held in the period betweenMarch–May 2014, in Rumah Sakit dr. Hasan Sadikin Bandung. The subjects were selected on the basis of consecutive sampling onpatients that are presented in the Emergency Departement and Cardiovascular Clinic. From 88 patients consisted of 44 patients withACS and 44 patients with stable angina, were tested for PRCP level in the serum using the ELISA sandwich method. This study wascarried out by observational design with cross sectional method. The statistical analysis uses the Saphiro Wilk data normality test,Mann Whitney test and Kruskal Wallis test. There was no characteristic difference between the two groups. This research identifiedsignificant difference of PRCP level between the ACS group and stable angina (P=0.005). Prolylcarboxy peptidase level in the ACS group(156,3×102 pg/mL) is higher compared to the stable angina (143.8×102pg/mL). PRCP level test hopefully can be recommended asone of the laboratorycal parameter in measuring the degree and instability of atherosclerosis plaque, in the absence of angiography orintravascular ultrasonography test facility.