Few data describe the role of registered nurses working in emergency departments in caring for ventilated patients, yet these patients may remain in the emergency department for prolonged durations because of the unavailability of intensive care unit beds. Our objective was to examine the exposure of emergency nurses to patients requiring mechanical ventilation, as well as their responsibilities and education on ventilation received.A cross-sectional mailed survey was sent to members of the National Emergency Nursing Association in Canada. Domains and items were refined from a survey of ventilation roles and responsibilities in intensive care.The response rate was 247 of 526 (47%); 39% of respondents provided care to 10 ventilated patients or fewer over a period of 2 weeks, 32% up to 5 patients or fewer monthly, and 27% to 5 patients or fewer over a period of 6 months. A 1:1 nurse-patient ratio for ventilated patients was reported by 38% of respondents, whereas 45% managed 1 or 2 additional patients and 15% managed 3 or more additional patients. Most respondents (54%) reported that respiratory therapists (RTs) remained in the emergency department until patients’ condition stabilized, 28% reported that an RT was on call, 11% reported that an RT remained until patient transfer, and 7% reported that no RT was available. Few nurses reported primary responsibility for initial ventilator setting selection (7%) or titration of ventilation (6%); nurse responsibility was influenced by RT availability (P < .001). Primary responsibility for monitoring patient response to ventilation, alarm troubleshooting, and oxygenation management was reported by 44%, 36%, and 30% of respondents, respectively. Education was received by 51% of respondents before exposure to ventilated patients; most (57%) indicated that competency was never assessed.Emergency nurses had variable exposure to ventilated patients. Responsibility for ventilator management was influenced by RT availability. Low nurse-patient ratios; inconsistent availability of education; lack of competency assessment; and infrequent use of guidelines, protocols, or pre-printed order sets pose potential concerns for patient safety while ventilated in the emergency department.

The joint consensus panel of the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently addressed present and future challenges in the laboratory diagnostics of atherogenic lipoproteins. Total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, and calculated non-HDL cholesterol (=total – HDL cholesterol) constitute the primary lipid panel for estimating risk of atherosclerotic cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDL cholesterol is the primary target of lipid-lowering therapies. For on-treatment follow-up, LDL cholesterol shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations. Lipoprotein(a)-cholesterol is part of measured or calculated LDL cholesterol and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDL cholesterol decline poorly upon statin treatment. Residual risk of ASCVD even under optimal LDL-lowering treatment should be also assessed by non-HDL cholesterol or apolipoprotein B, especially in patients with mild-to-moderate hypertriglyceridemia (2–10 mmol/L). Non-HDL cholesterol includes the assessment of remnant lipoprotein cholesterol and shall be reported in all standard lipid panels. Additional apolipoprotein B measurement can detect elevated LDL particle numbers often unidentified on the basis of LDL cholesterol alone. Reference intervals of lipids, lipoproteins, and apolipoproteins are reported for European men and women aged 20–100 years. However, laboratories shall flag abnormal lipid values with reference to therapeutic decision thresholds.

Back ground: Hypertension is one of the most important modifiable risk factors for cardiovascular disease (CVD) and stroke. Dyslipidemia is closely associated with hypertension. Dyslipidemia and hypertension are the commonest risk factors for CVD. The aim of the present study was to compare different lipid parameters among newly diagnosed hypertensive patients with normotensive subjects in Bangladesh and find out the relationship. Methods: This study was a cross sectional study in which 42 newly diagnosed hypertensive patients who were on no antihypertensive medication and 42 subjects with normal blood pressure (normotensive) were enrolled for compare. Lipid parameters total cholesterol (TC), triglyceride (TG), low density lipoprotein ( LDLc) and high density lipoprotein (HDLc) were estimated by Enzymatic colorimetric test. Results: The mean systolic blood pressure of hypertensive and normotensive were 154.6±22.5 vs111.50±3.42 mmof.Hg and mean diastolic blood pressure were 93.2±5.20 vs 71.44± 3.21mm of Hg. The mean of SBP and DBP of hypertensive patients was found to be higher than normotensive (p< 0.05). There was significant increase in different lipid levels namely TC 199.4±44.5 vs188.7±37.9 mg/dl, TG155.9±88.8 vs 121.9±73.2 mg/dl and LDLc 119.8±35.6 vs112.7±28.6 mg/dl in hypertensive patients as compared to normotensive (p<0.05). However there was no significant difference in HDLc level. BMI and waist circumference showed significant association in hypertensive patients (p<0.001). Conclusion: Analytical results of the study revealed that hypertensive patients have been found to have close association with dyslipidemia, BMI and waist circumference. Hypertension and dyslipidemia can be modified either by proper life style changes or medical management or by the combination of the both. This study suggests that hypertensive patients need measurement of blood pressure and lipid profile at regular interval to prevent heart diseases and stroke. DOI: http://dx.doi.org/10.3329/cardio.v6i2.18350 Cardiovasc. j. 2014; 6(2): 112-115

Background: Few studies have assessed the relation of Serum creatinine and serum blood urea nitrogen (BUN) level with the severity of coronary artery disease (CAD). This study investigated the association between high uric acid BUN levels with the presence of Coronary artery disease. Materials and Methods: This study was designed as an observational cohort study. The study was composed of 170 patients admitted at our institution due to symptoms related to CAD. Patients having angiographic evidence of stenosis in coronary artery were as case group and without stenosis control group. Patients with high serum creatinine were defined as serum creatinine concentration with in 80-105 ?mol/L and BUN level with in 10-20 ?mol/L. The presence of CAD has been defined as the Gensini score being >1. Results: Patients with or without CAD were similar in terms of age (45.22±6.80 years vs. 52.87±9.31 years, p<0.01) and significant age difference was found between patients. Male gender (p<0.001) and smoking habit (p=0.003) were more frequent and statistically significant in patients with CAD. There was a statistically significant difference between the mean serum creatinine levels (92.89±20.82 ?mol/L vs 108.68±23.62 ?mol/L respectively, p<0.05) and serum blood urea nitrogen level (10.59±6.15 ?mol/L vs. 20.37±6.73 ?mol/L respectively, p<0.01) of patients with or without CAD. While looking at the correlation coefficient of Gensini score with different factors; S. creatinine, ejection fraction and BUN were significantly correlated at<0.001 and <0.04 and <0.01 level respectively. Increased serum creatinine levels were found to be independent risk factors for the presence of CAD (for serum cretinine hazard ration 3.9, p<0.001 and in case BUN hazard ration 2.08, p<0.001). Conclusion: In conclusion, a significant association has been found between serum creatinine & BUN level and the presence of CAD. In addition to the evaluation of conventional risk factors in daily clinical practice, the measurement of serum creatinine and BUN level might provide significant prognostic benefits in terms of global cardiovascular risk and management of the patients. DOI: http://dx.doi.org/10.3329/cardio.v5i2.14282 Cardiovasc. j. 2013; 5(2): 141-145

Background: Metabolic syndrome (MS) results from clustering of cardiovascular risk factors occurring in association with insulin resistance and obesity. With the increasing prevalence of obesity worldwide, MS is of keen interest in research. The disorder is defined in various ways, but one consolidated definition is needed to make studies comparable worldwide. The study was to determine the risk factors of metabolic syndrome in Bangladesh and comparison of newly proposed definition of International Diabetes Federation (IDF), modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the World Health Organization (WHO) criteria and their agreements. Materials and Methods: This was a cross sectional hospital based study. We randomly selected 229 participants. After obtaining informed written consent data collectors collected data by interview, clinical examination, anthropometric measurement and investigations. We calculated independent sample t-test means between to distinguish which risk factors were present in participants with and without MS, using SPSS v17. Results: The percentage of risk factors of MS among subjects according to different criteria was 72% of Modified ATP-III, 69% of IDF and 39% of WHO definition .In Modified NCEP ATP III when did independent sample t-test mean of BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, high density lipoprotein and triglyceride were present statistically significant difference between without MS and with MS (p<0.05). According to WHO criteria BMI, waist circumference, fasting blood glucose were statistically significant (p<0.05) and similarly fasting blood glucose & triglyceride were statistically significant difference between without MS and with MS (p<0.05) according to IDF criteria.ATP III and WHO criteria showed good agreement (k 0.56) compared to ATP III with IDF (k 0.31) and WHO with IDF (k 0.11) criteria. Conclusion: Metabolic syndrome is highly prevalent in Bangladesh. We detected the highest proportion of participants with MS using the ATP III definition, which emphasizes the predominant focus on the modified waist circumference for Asian participants. However, MS prevalence following WHO criteria in those with impaired glucose regulation is comparable with ATP III definition. Follow up study needed to examine the significance of MS following all definitions for the assessment of risk for diabetes and or cardiovascular disease. Cardiovascular Journal Volume 6, No. 1, 2013, Page 17-22 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16110

Background : Blood testing for biochemical markers of Myocardial injury plays an increasingly important role for the evaluation, diagnosis and triage of patients with chest pain. The guidelines for the diagnosis of Myocardial Infarction ((MI) have recently changed and prominently incorporate the results of cardiac marker testing in the clinical definition of MI. We investigated these updated biomarkers and further compare the differing biology and release kinetics of clinically relevant biomarkers. Methods: Biochemical changes that occurred in the blood of acute myocardial infarction (AMI) patients were investigated. Two hundred and fifty two patients, 180 males and 72 females were included in this study. The mean age was 49.3 ± 9.25 years. Biochemical parameters include serum triglyceride, total protein, albumin , total bilirubin and total cholesterol to albumin ratio were analyzed. Results : Biochemical parameters showed that the increased level of triglyceride and total bilirubin were associated with myocardial infarction. Triglyceride and total bilirubin levels in myocardial infarction patients were 2.3 ±1.4 mmol/ L and 12.3±3.2 ?mol/ L respectively, whereas those of healthy controls were 1.7±1.2 mmol/L for triglycerides and 9.7±3.7 ?mol/L for bilirubin. On the other hand, serum total protein and albumin concentrations were lower in MI patients compared to those of controls. Total protein level was 65.5 ±3.1 g/L in MI patients and 76.2±5.3 g/L in healthy controls. Albumin levels in both patients and controls were 40.2 ±3.2 g/L and 45.4 ± 4.5 g/L correspondingly. Conclusion : Interestingly, serum total cholesterol level was not significantly different in MI patients compared to controls. In addition, cholesterol/albumin ratio in myocardial infarction patients (0.14 ± 0.04) found to be significantly higher than in healthy controls (0.11± 0.03). Cardiovascular Journal Volume 6, No. 1, 2013, Page 43-46 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16114

Background: Few studies have assessed the relation of uric acid level with the severity of coronary artery disease (CAD). This study investigated the association between high uric acid levels with the presence and severity of CAD.Materials and Methods: This study was designed as an observational cohort study. The study was composed of 180 patients admitted at our institution due to symptoms related to CAD. Patients having angiographic evidence of stenosis in coronary artery were as case group and without stenosis control group. Patients with high uric acid (hyperuricemia) were defined as serum uric acid concentration ?7.0mg/dl or ?420 ?mol/L in men and ?6mg/dl or ?360 ? mol/L in women. The presence of CAD has been defined as the Gensini score being ?1. Results: There was a statistically significant difference between the mean uric acid levels of patients with and without CAD (358.23±71.11 ?mol/l vs251.32±54.92 ?mol/l respectively, p<0.001). There was a statistically significant difference between ejection fraction of patients with and without CAD (54.50±9.25 vs. 63.16±6.56 respectively, p?0.001). Spearman correlation analysis demonstrated a positive correlation between the serum uric acid level and the severity of CAD (p=?0.001, r=0.39). When patients were classified into four groups according to their Gensini score, mean serum uric acid level was found to be significantly increased across the tertiles, and a statistically significant difference was detected between the tertiles (p= ?0.001). Conclusion: In conclusion, a significant association has been found between serum uric acid level and the presence and severity of CAD. In addition to the evaluation of conventional risk factors in daily clinical practice, the measurement of uric acid level might provide significant prognostic benefits in terms of global cardiovascular risk and management of the patients. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12206 Cardiovasc. j. 2012; 5(1): 12-17

DOI: http://dx.doi.org/10.3329/cardio.v4i1.9394Cardiovasc. J. 2011; 4(1): 75-79

Background: This experimental (Intervention) study was conducted with objective of evaluating the outcome of non-pharmacological approach (lifestyle intervention) through reducing the modifiable risk factors on high normal blood pressure or pre-hypertension (systolic blood pressure130- 139mm of Hg and diastolic blood pressure 85-89 mm of Hg).The study was provided risk reduction management intervention was given on subjects of high normal blood pressure through adequate physical activity, tobacco cessation, dietary advice for unhealthy to healthy diet, reduction of salt intake, reduction of over weight & stress management etc. Materials and methods: The study was conducted among 434 respondents aged 30 -50 years during the period from June 2008 to May 2009 with intervention for 6 months.Random sampling, those cases were fulfilled the inclusion and exclusion. High-normal BP were found out through BP measurement & clinical examination then sample population were selected by randomization: odds numbers in study group (intervention group) and even numbers in control group (comparision group). After obtaing informed consent data were collected by interview, clinical examination, anthropometric measurement and investigations. It was three phases, first phase were case identification & intervention for study group, second phase was follow up and third phase was outcome measurement for both groups. Cases were hold a record card with contact number. Results: After six month mean difference of blood pressure, lipid profile, weight were changed both the groups but changed was significant in the study group. Mean systolic blood pressure reduced 4.1±6.0 in the study group and 1.2±6.4 in the control group,(p< 0.001). Mean diastolic pressure reduced 3.5±4.9 in study group and 1.2±6.4 in control group (p<0.001). Mean total cholesterol, LDL cholesterol and triglycerides decreased in the study group 19.7±18.6, 10.6±14.6 and 15.4 ±21 respectivley and in control group mean of all these parameters decreased to 11.5±16.5, 5.1±12.9 and 6.7±23.2 respectively. Mean HDL cholesterol for men and women in the study group was raised to 5.6±5.9 and 4.5± 6.4 respectively (p<0.001). Mean weight reduced 1.94±1.59 in study group and 0.06±1.44 in the control group (p<0.001). Conclusion: The final outcome of the study was that mean high normal blood pressure was found to reduced due to intervention of non- pharmacological management. So, If we encourages subjects after 40 years for routine health check up in hospital setting & service for risk factor detection & management (preventive cardiology), we will reduce the risk factors of high normal blood pressure (pre-hypertension) & cardiovascular diseases to some extent. Encourages population to stay with normal blood pressure & healthy life style. Keywords: High-normal blood pressure; Pre-hypertension; Life style modification; Nonpharmacological intervention. DOI: 10.3329/cardio.v2i2.6639 Cardiovasc. j. 2010; 2(2) : 195-203