Current Issue : October - December Volume : 2019 Issue Number : 4 Articles : 5 Articles
Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening complication of pregnancy.\nThere is limited data regarding the predictors of persistent left ventricular (LV) systolic dysfunction. Recently, monocyteto-\nhigh density lipoprotein (HDL) cholesterol ratio (MHR) has emerged as a novel indicator of inflammation and\noxidative stress. We aimed to assess the predictive value of MHR on LV recovery in patients with PPCM.\nMethods: A total of 64 patients with PPCM who admitted to our tertiary reference hospital between 2009 and 2017\nwere retrospectively analyzed in this study. Demographic and clinical data, laboratory parameters and echocardiographic\nfindings were recorded. The duration of follow-up was at least 12months after diagnosis for all participants. Recovery of\nLV systolic function was defined as the presence of LV ejection fraction (LV EF) > 45%. Univariate analysis was used to\ndetermine the significant predictors of persistent LV systolic dysfunction (non-recovery). A receiver operating characteristic\n(ROC) curve was used to establish the cut-off values for predictors..........................
Background: Impaired renal function increases the bleeding risk, leading to a conservative prescription and\nfrequent discontinuation of oral anticoagulation in atrial fibrillation patients with chronic kidney disease (CKD).\nInterventional left atrial appendage closure (LAAC) might be an alternative therapeutic strategy for these patients.\nMethods: We aimed to prospectively assess cerebrovascular (CE) and bleeding events, as well as peri-procedural\nand long-term complications in a cohort of consecutive patients undergoing interventional LAAC using the\nWATCHMANâ?¢ device, with focus on CKD patients.\nResults: One hundred and eighty-nine consecutive patients undergoing interventional LAAC were included in this\nanalysis; 171 (90.5%) patients had a reduced estimated glomerular filtration rate (eGFR; patients for each CKD stage: II =\n66; IIIa = 32; IIIb = 43; IV = 18; V = 12). During a follow-up of 310 patient years three (1.0%) patients suffered a CE (two\nstrokes, one transitory ischemic attack) and five (1.6%) other ones a bleeding complication. The observed stroke rate\nwas more than two-thirds and the bleeding risk more than half lower than expected. Device related thrombi (DRT)\nwere detected in twelve (6.5%) patients; women had significantly more DRT than men (12.5% vs. 2.6%; p = 0.009).\nPatients with an eGFR< 30ml/min/1.73m^2 showed a trend to a higher DRT rate as compared to the opposite group\n(13.3% vs. 5.1%; p = 0.10). Thrombus resolved with temporary oral anticoagulation therapy in ten patients without\nsequelae; thrombus consolidation was confirmed by serial TEE controls in the remaining two patients.\nConclusions: Atrial fibrillation patients with CKD have low CE and bleeding rates after LAAC with the WATCHMANâ?¢\ndevice. DRT risk is higher in female and patients with severe CKD. More frequent post-interventional TEE controls might\nbe justified for early DRT detection and safe management of patients at high DRT risk....
Our study aims to observe the levels of knowledge, attitude, and practice (KAP) associated with sickle cell disease (SCD) and premarital genetic counseling (PMGC) in 351 Saudi adults. The relationships between KAP levels and sociodemographic characteristics (age, gender,marital status, and educational level)were observed.Thestudywas conducted inKingKhalidUniversity Hospital between February 21, 2017, and March 7, 2018. A total of 351 Saudi participants attending the primary care clinic were selected using convenience sampling and were given a self-administered questionnaire. Overall, the 351 participants had the best attitude (41% scoring â??goodâ?), followed by knowledge (28.8%), and, lastly, practice (19.1%). Out of the sociodemographic characteristics, age group was the most statistically significant in all the three categories (knowledge, attitude, and practice).The >50-year age group performed the worst in all the three categories. Despite the advancements in public healthcaremeasures in Saudi Arabia, our study revealed that there are still many gaps to be filled regarding the knowledge, attitude, and practice associated with\nSCD and PMGC....
Introduction: Coronary artery disease (CAD) is one of the most common\ncauses of death worldwide. In 2010, about 7 out of total 53 million deaths\nwere due to ischemic heart disease. The aim of this study is to evaluate the\nrelationship of serum bilirubin level with the severity and complexity of coronary\nartery disease (CAD) in the patients undergoing primary percutaneous\ncoronary intervention (PCI). Materials and Methods: 70 patients with\nSTEMI who were undergoing primary PCI were included in the study. All the\npatients included in the study were subjected to full routine investigations\nand standard coronary angiographic projections. Total bilirubin level was\nmeasured and the patients were divided into two groups.Group 1 was with\nserum TB (<1 mg/dl) and Group 2 was with serum TB (>1 mg/dl). Severity\nand complexity of coronary artery lesions will be assessed using Gensini\nscore. Results: After PCI, the two studied groups were compared regarding\nthe number of vessels affected by one and more than one vessel disease. Single\nvessel disease was frequent in Group 2 (71%) with significant p value\n(0.003). Cardiac enzymes (troponin I) was more in Group 1 (S. Bil < 1) with\nsignificant p value (0.02). Also (ALT, AST) were more in Group 1 (p value =\n0.01). By comparing the 2 groups, there was a significant difference regarding\n(EF) between both which was less in Group 1 (S.TB < 1) than Group 2\n(S.TB > 1), p value significance (0, 0001). Also GENSENI was more in Group\n1 (S.TB < 1) than Group 2 (S.TB > 1) with mean (80.35 vs 34.71) and significant\np value (0.0001). There was a highly significant negative correlation between\nserum bilirubin & GENSENI score (r = -0.762, p value 0.0001). Regarding\nthe incidence of complications, incidence was more in Group 1 (S.TB\n< 1) than in Group 2 (S.TB > 1), which means a significant difference between\n both groups with significant p value (0.0001). There was a significant\nnegative correlation between serum bilirubin & incidence of complications (R\n= -0.38, p value 0.001). Also, there was a significant negative correlation between\nGENSINI score, complication and bilirubin among both groups (r:-0.762\\-0.38)\n with p value (0.0001\\0.001) respectively. Conclusion: In conclusion,\nour results suggested that the Serum Bilirubin level is inversely correlated\nwith the severity of CAD. Also, the SB level is an independent predictor\nof cardiovascular events in CAD patients. Understandably, our findings\nneed further verification by large-scale, multicenter clinical trials in the future....
Background: Coronary artery disease (CAD) is associated with poorer outcomes after aortic valve replacement\n(AVR). For high-risk patients with complex CAD, combined transcatheter aortic valve replacement (TAVR) plus offpump/\nminimally-invasive coronary artery bypass (OPCAB/MIDCAB) has been proposed.\nMethods: A prospective registry analysis was performed to compare the characteristics and outcomes of patients\nundergoing TAVR+OP/MIDCAB with those undergoing TAVR plus percutaneous coronary intervention (PCI) and\nsurgical AVR plus coronary artery bypass grafting (CABG) between 2008 and 2015 at a single site in Germany.\nResults: 464 patients underwent SAVR+CABG, 50 underwent TAVR+OP/MIDCAB, and 112 underwent TAVR+PCI.\nThe mean ages (p < 0.001) and logistic EuroSCOREs (p < 0.001) were similarly higher in TAVR+OP/MIDCAB and\nTAVR+PCI patients compared to SAVR+CABG patients. Prior cardiac surgery was more common in TAVR+PCI\nthan in TAVR+OP/MIDCAB and SAVR+CABG patients (p < 0.001). Procedural times were shortest (p < 0.001),\ncreatine kinase (muscle brain) levels least elevated (p < 0.001), pericardial tamponade least common (p = 0.027),\nand length of hospital stay shortest (p = 0.011) in TAVR+PCI, followed by TAVR+OP/MIDCAB and SAVR+CABG\npatients. In-hospital mortality was highest for TAVR+OP/MIDCAB patients (18.0%) with comparable rates for\nTAVR+PCI and SAVR+CABG groups (9.0 and 6.9%; p = 0.009). Mortality by 12 months was more probable after\nTAVR+OP/MIDCAB (HR: 2.17, p = 0.002) and TAVR/PCI (HR: 1.63, p=0.010) than after SAVR+CABG, with the\nsame true of rehospitalisation (HR: 2.39, p = 0.003 and HR: 1.63, p = 0.033).\nConclusions: TAVR+OP/MIDCAB patients share many characteristics with TAVR+PCI patients, with only slightly\npoorer long-term outcomes. In patients ineligible for SAVR+CABG and TAVR+PCI, hybrid interventions are\nreasonable second-line options....
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