The Role of Neutrophil to Lymphocyte Ratio and its Common Clinical Outcomes Among Patients with Non-ST Elevation Acute Coronary Syndrome.

Objectives: To evaluate the admission neutrophil-to-lymphocyte ratio (NLR) for risk stratification for in-hospital outcomes and complications in non-ST-elevation acute coronary syndrome (non-ST-ACS) patients. Methods: We recruited consecutive patients with non-ST-ACS. The NLR was obtained and stratified as low, intermediate, and high-risk based on <3.0, 3.0-6.0, and >6.0, respectively. The new ST-T changes, arrhythmias, contrast-induced nephropathy (CIN), and mortality were recorded. Results: Median NLR was 3 [2.1-5.3] for 346 patients with 19.9% and 30.6% in high- and intermediate-risk group. New ST-T changes were observed in 3.5% (12) out of which 8, 3, and 1 patient in low, intermediate, and high-risk group (p = 0.424), respectively. Arrhythmias were observed in 5.8% (20) with 7, 5, and 8 patients in low, intermediate, and high-risk group (p = 0.067), respectively. CIN was observed in 4.9% (17) with 5, 5, and 7 in low, intermediate, and high-risk group (p = 0.064), respectively. In-hospital mortality was recorded in 1.4% (5) with 2 and 3 patients in high and low-risk group (p = 0.260), respectively. Conclusion: A significant number of non-ST-ACS patients fall in the high-risk category of NLR. Although, the association between NLR and in-hospital mortality and adverse events was not statistically significant but relatively higher rates of events were observed in high risk group.

Attitude towards professional practice among community pharmacists' in Kuala Lumpur, Malaysia / Actitud hacia la práctica profesional entre los farmacéuticos comunitarios en Kuala Lumpur, Malasia

OBJECTIVES: This study was directed to evaluate community pharmacists' attitudes towards professional practice and determine their observed competence in various pharmaceutical activities. METHODS: A cross-sectional study conducted in the city of Kuala Lumpur. The questionnaire contained 40 questions splitted into six sections that addressed several aspects of practice and demographic information. The study was involved in 223 licensed pharmacists who work in community pharmacies. Data were analyzed by using SPSS. Chi-square and Pearson's correlation tests were used for statistical significance for dichotomous data. Key findings: Among the 233 respondents in managerial activities, 194 (87%) achieved the score good, and 5 (2.2%) had the score poor. In dispensing activities, 199 (89.2%) achieved the score good, and 5 (2.2%) had the score poor. In pharmaceutical care activities, 209 (93.7%) got the score good, and 4 (1.8%) got the score poor. In inter/intra professional activities, 108 (48.4%) got the score good, and 10 (4.5%) got the score poor. In public health activities, 153 (68.6%) got the score good, and 6 (2.7%) got the score poor whereas in the maintenance of competency activities, 160 (71.7%) got the score good, and 3 (1.3%) got the score poor. CONCLUSIONS: The highest of participants got a good attitude was 93.7% for pharmaceutical care activities while the highest of participants got poor attitude was 4.5% for inter/intra professional activities. The majority of the participants are accepting the activities to maintain competence

OBJETIVOS: Este estudio se dirigió a evaluar las actitudes de los farmacéuticos comunitarios hacia la práctica profesional y determinar su competencia observada en diversas actividades farmacéuticas. MÉTODOS: estudio transversal realizado en la ciudad de Kuala Lumpur. El cuestionario contenía 40 preguntas divididas en seis secciones que abordaban varios aspectos de la práctica y la información demográfica. En el estudio participaron 223 farmacéuticos con licencia que trabajan en farmacias comunitarias. Los datos se analizaron utilizando SPSS. Se utilizaron pruebas de correlación de Chi-cuadrado y Pearson para determinar la significación estadística de los datos dicotómicos. Hallazgos clave: Entre los 233 encuestados en actividades de gestión, 194 (87%) obtuvieron una puntuación buena y 5 (2,2%) obtuvieron una puntuación mala. En las actividades de dispensación, 199 (89,2%) obtuvieron la puntuación buena y 5 (2,2%) obtuvieron la puntuación mala. En las actividades de atención farmacéutica, 209 (93,7%) obtuvieron una buena puntuación y 4 (1,8%) obtuvieron una mala puntuación. En actividades inter / intraprofesionales, 108 (48,4%) puntuaron bien y 10 (4,5%) puntuaron mal. En las actividades de salud pública, 153 (68,6%) obtuvieron la puntuación buena y 6 (2,7%) obtuvieron la puntuación mala, mientras que en las actividades de mantenimiento de competencias, 160 (71,7%) obtuvieron la puntuación buena y 3 (1,3%) obtuvieron el puntaje pobre. CONCLUSIONES: La mayor parte de los participantes obtuvo una buena actitud fue del 93,7% para las actividades de atención farmacéutica mientras que la mayor de los participantes obtuvo una mala actitud fue del 4,5% para las actividades inter / intraprofesionales. La mayoría de los participantes aceptan las actividades para mantener la competencia

Ventricular septal defect and associated complications.

OBJECTIVE: To determine the frequency of various types of ventricular septal defects (VSD) and associated complications in local paediatric population. METHODS: A cross sectional descriptive study was conducted on children undergoing echocardiography in a single centre from January 2006 to December 2009 at Paediatric Cardiology Department, Ch. Pervaiz Elahi Institute of Cardiology Multan- Tertiary referral centre for paediatric and adult cardiac services in South Punjab. The data on all children below 15 years of age undergoing detailed transthoracic two-dimensional echo and Doppler studies was reviewed. Cases with isolated ventricular septal defects were studied for age of presentation, gender, type, and associated complications. The data was analyzed with SPSS 11 version. RESULTS: A total of 5018 patients with congenital heart diseases underwent echocardiography during this period. A total of 1276 patients had isolated VSD (25%). Mean age was 3.1 +/- 3.64 years (range: 1 day to 15 years). Females were 440 (34.5%) and males were 836 (66.5%). Of 1276 patients, 1014 (79.3%) were Perimembranous type, 124 (9.8%) were muscular type, 85 (6.7%) were doubly committed subarterial type and 53 (4.2%) inlet VSD. Small, moderate and large VSDs were 428 (33.6%), 443 (34.7%) and 405 (31.7%) respectively. Severe pulmonary hypertension was noted in 286 (22.4%) cases. Aortic valve prolapse was present in 85 (6.7%) cases and varying degrees of aortic valve regurgitation was seen in 67 (5.2 %) patients. Right ventricular outflow tract obstruction was found in 21 (1.6%) cases. Left ventricular outflow tract obstruction was noted in 09 (0.7%) cases. Echo evidence of infective endocarditis was present in 06 (0.5%) patients. CONCLUSION: Perimembranous ventricular septal defect was found to be the commonest type of ventricular septal defect. Large ventricular septal defects usually lead to severe pulmonary hypertension. Severe pulmonary hypertension was the commonest complication followed by Aortic Valve Prolapse and Aortic Regurgitation. Rest of the complications were rare.