Biallelic Mutations in Tetratricopeptide Repeat Domain 26 (Intraflagellar Transport 56) Cause Severe Biliary Ciliopathy in Humans.

BACKGROUND AND AIMS: The clinical consequences of defective primary cilium (ciliopathies) are characterized by marked phenotypic and genetic heterogeneity. Although fibrocystic liver disease is an established ciliopathy phenotype, severe neonatal cholestasis is rarely recognized as such. APPROACH AND RESULTS: We describe seven individuals from seven families with syndromic ciliopathy clinical features, including severe neonatal cholestasis (lethal in one and necessitating liver transplant in two). Positional mapping revealed a single critical locus on chromosome 7. Whole-exome sequencing revealed three different homozygous variants in Tetratricopeptide Repeat Domain 26 (TTC26) that fully segregated with the phenotype. TTC26 (intraflagellar transport [IFT] 56/DYF13) is an atypical component of IFT-B complex, and deficiency of its highly conserved orthologs has been consistently shown to cause defective ciliary function in several model organisms. We show that cilia in TTC26-mutated patient cells display variable length and impaired function, as indicated by dysregulated sonic hedgehog signaling, abnormal staining for IFT-B components, and transcriptomic clustering with cells derived from individuals with closely related ciliopathies. We also demonstrate a strong expression of Ttc26 in the embryonic mouse liver in a pattern consistent with its proposed role in the normal development of the intrahepatic biliary system. CONCLUSIONS: In addition to establishing a TTC26-related ciliopathy phenotype in humans, our results highlight the importance of considering ciliopathies in the differential diagnosis of severe neonatal cholestasis even in the absence of more typical features.

Medications adherence post-primary percutaneous coronary intervention in acute myocardial infarction: A population-based cohort study.

WHAT IS KNOWN AND OBJECTIVE: The use of medications for secondary prevention is the cornerstone in the treatment of coronary artery disease (CAD). However, adherence to these medications is still suboptimal worldwide. This retrospective observational study aimed to assess the adherence to post-percutaneous coronary intervention (PCI) medications, along with predictors of non-adherence. METHODS: We conducted a retrospective observational cohort study to assess the adherence to post-PCI medications by determining the rate of prescription refills for 12 months after discharge among STEMI patients, as well as predictors of non-adherence. Adherence was assessed by medication availability 80% of the time monitored by the prescription refills rate for 1 year post-discharge. RESULTS AND DISCUSSION: A total of 1334 patients who presented with STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with a mean age of 51 ± 10.2 years. The overall adherence rate for all medications was only 28.4%, with an individual adherence rate of 50.5% for aspirin, 49.9% for P2 Y12 inhibitors, 48.1% for statins, 39.6% for beta-blockers and 42.9% for angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB). Factors that increased the likelihood of non-adherence were prolonged hospital length of stay and getting the medications with charge (aOR = 1.94, 95% CI 1.1-3.3; p-value = 0.017, aOR = 1.87, 95% CI 1.1-3.3; p-value = 0.029, respectively), while having a regular follow-up after discharge and attending the first clinic appointment were significantly associated with decreased likelihood of non-adherence (aOR = 0.01, 95% CI 0.004-0.04; p-value < 0.001, aOR = 0.06, 95% CI 0.03-0.1; p-value < 0.001, respectively). WHAT IS NEW AND CONCLUSION: The adherence rate to post-PCI medications among patients with STEMI was relatively low; however, attending the first outpatient clinic appointment and having a regular follow-up reduced the likelihood of non-adherence.

Predictors of women empowerment knowledge and attitude among Saudi academic and administrative staff: A cross-sectional study.

The KSA 2030 vision makes special reference to women's empowerment as an important strategy for Saudi community transformation. Studies related to women's empowerment, especially in the Saudi context, are still not enough and unclear. The current study explored the predictors of women empowerment knowledge and attitudes among Saudi academic and administrative staff. A cross-sectional study was conducted at 15 Saudi government-owned universities. A multistage cluster sampling technique was used to select 5587 participants during the period April to September 2020. The study instrument consisting of three main parts; basic demographic data, questionnaire assessed the knowledge regarding women's empowerment, and women empowerment attitude scale. The results showed good knowledge of empowerment among the women with 75.5% of the participants demonstrating good knowledge. The total women empowerment attitude was positive among 65.9% of the participants. The association between demographic data and women empowerment knowledge and attitude showed a significant association with marital status, residence, education, and occupation (p <0.05). Linear regression on marital status, education, residence, and occupation, are confirmed as significant predictors of women empowerment knowledge and attitude (p <0.05). Mother's education level is shown as a predictor for women empowerment attitude (p>0.005). Three-quarters of Saudi academic and administrative staff have a good women empowerment knowledge score, and more than two-thirds have a positive attitude. Demographic characteristics are important predictors for women empowerment knowledge and attitude. The results of this study will help decision-makers to design and implement goal-directed women empowerment programs.

Empowering Saudi women in higher educational institutions: Development and validation of a novel women empowerment scale.

The government in Saudi Arabia in 2016 declared the necessity to overcome the ancestral oil-based economy and move towards a more diversified model. One of the significant steps to achieve this goal is to empower Saudi women, who form half of the Saudi population, to actively contribute their much-needed talents and skills to the Saudi labour market. However, there is a scarcity of existing scales to measure women empowerment in Saudi Arabia. The objective of this study was to construct and validate a reliable novel scale for the empowerment of Saudi women employed in higher education institutions. A methodological study was conducted from January to April 2020 among Saudi women academic and administrative staff (n=160) working in the higher educational institutions located in the northwestern and southern regions of Saudi Arabia. The tool underwent content and face validity as well as factor analyses. Internal consistency was analyzed through Cronbach's alpha and Pearson correlation coefficient. The data analysis was conducted using IBM SPSS version 23. A Cronbach's alpha value of 0.94 was obtained in reliability analysis. The results showed that the total women empowerment scale had an exceptional internal consistency (>9). The three domains of the scale and total woman empowerment scale had a score close to 1, indicating a high Intraclass Correlation Coefficient, and showed a high similarity between values at the second and third measurements. Self-esteem and self-efficacy subscales were the most important indicators of women's' personal empowerment. Furthermore, a highly positive correlation (p <0.01) was found between the total domains of empowerment scale. A novel women empowerment tool was developed and validated in Saudi women working as academic and administrative staff. This can serve as a reliable tool to measure women's empowerment in higher education institutions. It will eventually enable the formulation of strategies that facilitate women's empowerment and pave the path for a strong foundation for the development of the country.

Women empowerment among academic and administrative staff in Saudi universities: A cross-sectional study.

Women in Saudi Arabia constitute nearly 50% of the population, but their participation in economic and social activities are far below the kingdom's potential. According to the 2030 vision, women empowerment is an essential requirement for community transformation and development. The study aims to explore women empowerment among academic and administrative staff in Saudi Universities. A cross-sectional research design was conducted at 15 Saudi governmental universities. A multistage cluster sampling technique was followed to select 5587 participants. The data collection starts from April to September 2020. The current study results illustrate statistically significant differences between academic and administrative staff in the total women empowerment score and all of its dimensions (p <0.05). The majority of academic staff (84.4%) have high personal empowerment compared to 73.7% of the administrative staff. The study concluded that women empowerment is higher among academics compared to administrative staff in Saudi Universities.

The role of self-esteem and self-efficacy in women empowerment in the Kingdom of Saudi Arabia: A cross-sectional study.

The study aimed to explore the role of self-esteem and self-efficacy in women empowerment among academic and administrative staff at Saudi universities. A cross-sectional design was carried out at 15 governmental universities. A multistage cluster sampling technique was used to select 5587 participants. Multiple linear regression was used to analyze the predictive relation. Data collection included socio-demographic variables, Rosenberg self-esteem scale, general self-efficacy scale, and women empowerment scale. The results indicated that study participants' self-esteem was equally distributed between moderate (49.8%) and high (50.2%). Also, 66.9% of the participants had high self-efficacy, and 86.8% had high total women's empowerment. Regression coefficient showed that self-esteem (B=0.521, b=0.127, t=13.785 and p <0.001) and self-efficacy (B=2.388, b=0.702, t=76.049 and p <0.001) are important predictors of the total women empowerment. However, self-efficacy was observed to be the most dominant predictor (t=76.049). The total model summary shows that 73.4% of the women empowerment level can be predicted through self-esteem and self-efficacy. The study results can be used as a base to build women empowerment programs in the Kingdom of Saudi Arabia (KSA) and help to achieve the 2030 KSA vision regarding women empowerment.

Perceived and real barriers to workplace empowerment among women at Saudi universities: A cross-sectional study.

Academic women in the Arab world, especially Saudi women, have numerous barriers inhibiting their leadership power at the workplace. The current study explores the perceived and real barriers to workplace empowerment among women at Saudi universities. A descriptive cross-sectional study was carried out at 15 Saudi governmental universities. A multistage cluster sampling technique was followed to select (5587 participants) The data collection started from the beginning of April to the beginning of September 2020. SPSS 23.0 was used to analyze data using descriptive statistics. Multiple linear regression was used to identify the real barriers to women empowerment at the workplace. The study showed that 52.1% of the study participants had moderate workplace empowerment, and only 10.2% have a low level. Regarding perceived barriers to workplace empowerment, 42.6% of the participants agree that male dominance was a barrier. Moreover, 36.2% of the participants agreed and strongly agree that the customs and traditions are a barrier to women empowerment at the workplace. Multiple linear regression showed that age, followed by years of experience (p <0.000), were the most significant demographic predictors of women empowerment at the workplace. Moreover, positive attitude, high self-esteem, and good knowledge (p <0.000) were considered other variables that positively predict women's empowerment at the workplace. The experience of gender-based violence (p <0.000) was a negative predictor of women empowerment at the workplace. The study concluded that around 62.3% of Saudi female academics and administrative staff have moderate or low workplace empowerment at Saudi Universities. Male dominance is perceived as the highest barrier.

COVID-19 Outbreak: Effect of an Educational Intervention Based on Health Belief Model on Nursing Students' Awareness and Health Beliefs at Najran University, Kingdom of Saudi Arabia.

This study aimed to investigate the effect of an educational intervention based on the health belief model (HBM) about COVID- 19 on nursing students' awareness and health beliefs. A true-experimental research design was conducted at nursing college, Najran University, KSA. A comprehensive sampling was followed to include all female students at the colleges (164 students). The sample was divided randomly into intervention (82) and control group (82). The educational intervention was designed and conducted based on the HBM through four sequential phases: assessment, planning, implementation, and evaluation. The current study results indicated no statistically significant differences between intervention and control groups concerning their demographic characteristic, awareness, and health beliefs before intervention. After intervention, significant differences (p < 0.05) were observed between intervention and control groups in their awareness and all HBM constructs regarding COVID19. There were positive, statistically significant correlations (P < 0.05) between participants' total HBM score and their total awareness score. This study concluded that HBM is effective in increasing nursing students' awareness regarding COVID-19. It also increases their perceived susceptibility, severity, and benefits. Besides, it may increase their self-efficacy to overcome perceived barriers to practice protective and preventive actions while dealing with COVID-19.

Precipitating Factors for Hospitalization with Heart Failure: Prevalence and Clinical Impact Observations from the Gulf CARE (Gulf aCute heArt failuRe rEgistry).

OBJECTIVE: Despite the expanding burden of heart failure (HF) worldwide, data on HF precipitating factors (PFs) in developing countries, particularly the Middle East, are very limited. We examined PFs in patients hospitalized with acute HF in a prospective multicenter HF registry from 7 countries in the Middle East. METHOD: Data were derived from the Gulf CARE (Gulf aCute heArt failuRe rEgistry) for a prospective, multinational, multicenter study of consecutive patients hospitalized with HF in 47 hospitals in 7 Middle Eastern countries between February 2012 and November 2012. PFs were determined by the treating physician from a predefined list at the time of hospitalization. RESULTS: The study included 5,005 patients hospitalized with acute HF, 2,276 of whom (45.5%) were hospitalized with acute new-onset HF (NOHF) and 2,729 of whom (54.5%) had acute decompensated chronic HF (DCHF). PFs were identified in 4,319 patients (86.3%). The most common PF in the NOHF group was acute coronary syndromes (ACS) (39.2%). In the DCHF group, it was noncompliance with medications (27.8%). Overall, noncompliance with medications was associated with a lower inhospital mortality (OR 0.47; 95% CI 0.28-0.80; p = 0.005) but a higher 1-year mortality (OR 1.43; 95% CI 1.1-1.85; p = 0.007). ACS was associated with higher inhospital mortality (OR 1.84; 95% CI 1.26-2.68; p = 0.002) and higher 1-year mortality (OR 1.62; 95% CI 1.27-2.06; p = 0.001). CONCLUSION: Preventive and therapeutic interventions specifically directed at noncompliance with medications and ACS are warranted in our region.

COVID-19 Pandemic: Psycho-social Consequences During the Social Distancing Period Among Najran City Population.

BACKGROUND: COVID-19 is a global pandemic that endanger the health and enforced social distancing for the whole world. Social distancing may generate stress, anxiety, and depression. Understanding the psychosocial consequences of COVID19 during social distancing may help decision-makers to take suitable decisions that help in increasing awareness. Evaluate the psychosocial consequences of COVID-19 pandemic during the social distancing period and explore the relationship between social media use and psychological stress during COVID-19 outbreak among Najran city population. Research design is descriptive correlational research design. SUBJECTS AND METHODS: A snowball sampling technique, was used to recruit participants live in Najran city during the COVID-19 pandemic (1508 participant). RESULTS: A statistically significant differences (P<0.05) are observed between Saudi and non-Saudi participants in all social aspects assessed except for time spent on social media. In addition, a high mean of depression, stress, and anxiety subscale scores are observed in non-Saudi compared to the Saudi participants with statistically significant differences (p=0.000). As well as high DASS-21 total scores in non-Saudi compared to the Saudi participants. Also, there are positive statistically significant correlations (≤0.05) between participants' time spent in social media and their depression, stress, anxiety, and total DASS scores during the COVID-19 outbreak. CONCLUSION: The findings of the present study indicate that COVID-19 pandemic generates stress, anxiety and depression among Najran population especially, non-Saudi. This poor psychological condition is exaggerated with prolonged social media use. COVID-19 also has negative impact on social wellbeing and use of social media cannot replace direct contact with friends. The current study results may be utilized to formulate interventions that enhance psychosocial health and resilience during the COVID-19 outbreak.

The cardiovascular implication of single nucleotide polymorphisms of chromosome 9p21 locus among Arab population.

BACKGROUND: Based on several reports including genome-wide association studies, genetic variability has been linked with higher (nearly half) susceptibility toward coronary artery disease (CAD). We aimed to evaluate the association of chromosome 9p21 single nucleotide polymorphisms (SNPs): rs2383207, rs10757278, and rs10757274 with the risk and severity of CAD among Arab population. MATERIALS AND METHODS: A prospective observational case-control study was conducted between 2011 and 2012, in which 236 patients with CAD were recruited from the Heart Hospital in Qatar. Patients were categorized according to their coronary angiographic findings. Also, 152 healthy volunteers were studied to determine if SNPs are associated with risk of CAD. All subjects were genotyped for SNPs (rs2383207, rs2383206, rs10757274 and rs10757278) using allele-specific real-time polymerase chain reaction. RESULTS: Patients with CAD had a mean age of 57 ± 10; of them 77% were males, 54% diabetics, and 25% had family history of CAD. All SNPs were in Hardy-Weinberg equilibrium except rs2383206, with call rate >97%. After adjusting for age, sex and body mass index, the carriers of GG genotype for rs2383207 have increased the risk of having CAD with odds ratio (OR) of 1.52 (95% confidence interval [CI] = 1.01-2.961, P = 0.046). Also, rs2383207 contributed to CAD severity with adjusted OR 1.80 (95% CI = 1.04-3.12, P = 0.035) based on the dominant genetic model. The other SNPs (rs10757274 and rs10757278) showed no significant association with the risk of CAD or its severity. CONCLUSION: Among Arab population in Qatar, only G allele of rs2483207 SNP is significantly associated with risk of CAD and its severity.

Evaluation of warfarin management in primary health care centers in Qatar: A retrospective cross-sectional analysis of the national dataset.

BACKGROUND: Warfarin management is associated with severe complications, highlighting the critical need to evaluate the quality of its administration. OBJECTIVES: To evaluate the quality of warfarin management for patients managed in primary healthcare centers by measuring the percentage of Time in Therapeutic Range (TTR) and the proportion of extreme out-of-range international normalized ratio (INR) values. METHODS: This is a cross-sectional study. Data was extracted from a national dataset retrieved from the largest primary healthcare provider in Qatar. TTR was calculated using the traditional method. Inferential and descriptive analyses were performed as appropriate. RESULTS: Four hundred ninety-four patients met the inclusion criteria. The mean (SD) TTR was 45.3 % (17.5). This was significantly lower than the recommended cutoff value (P<0.001). Extreme out-of-range INR accounted for 24.7 % of total INR readings. CONCLUSIONS: The management of patients taking warfarin in Qatar is inadequate. More effective strategies are warranted to ensure safe and effective therapy.

Atrial fibrillation in Middle Eastern Arab and South Asian patients hospitalized with acute myocardial infarction: experience from a 20-year registry in qatar (1991-2010).

BACKGROUND: Recent evidence suggests that there are ethnic variations in atrial fibrillation (AF) susceptibility and incidence following acute myocardial infarction (AMI). OBJECTIVES: The aim of this study was to evaluate the incidence and predictors of AF in the setting of AMI in Middle Eastern Arab and South Asian patients and its impact on in-hospital morbidity and mortality. METHODS: A retrospective analysis of a prospective registry of all patients hospitalized with AMI in the state of Qatar from 1991 through 2010 was made. Clinical characteristics and outcomes of AMI patients with and without AF were compared. Sub-analysis according to ethnicity was also performed. RESULTS: During the 20-year period; a total of 12,881 patients were hospitalized with AMI. Of these 5028 were Arabs and 5985 were South Asians. A total of 227 had AF during hospitalization with an overall incidence of 1.8% (156 Arabs; incidence 3.1% and 48 South Asians; incidence 0.8%). The mean age of AF patients was 65 years (Arabs 69, South Asians 54). Patients with AF were significantly older and had more cardiovascular co-morbidities than patients without AF, and were more likely to have non-ST elevation AMI on presentation. Patients with AF had significantly higher in-hospital mortality rate (20.3% versus 7.1%; P=0.001) and stroke rates (1.8% versus 0.3%; P=0.001) when compared to patients without AF. Age was the only independent predictor of AF development in patients with AMI in our study. CONCLUSIONS: Our study reports variability in the prevalence of AF among AMI patients according to ethnicity using a 20-year registry from a Middle Eastern country. Advancing age was the major independent predictor of AF in our AMI patients. Further prospective studies are required evaluating optimal therapeutic approaches for these high-risk patients in order to reduce the high mortality observed.

Clean hands, safe care: how knowledge, attitude, and practice impact hand hygiene among nurses in Najran, Saudi Arabia.

Introduction: Healthcare-acquired infections are infections that patients acquire while receiving treatment for a medical or surgical condition and can occur in all care facilities. Hospital-acquired infections and the spread of antimicrobial resistance can be reduced by implementing proper preventive measures, including hand hygiene. Aim: This study aimed to assess nurses' knowledge and attitudes toward hand hygiene guidelines in Najran city, determine compliance levels, identify factors contributing to non-compliance, and provide recommendations for interventions to improve hand hygiene practices and reduce healthcare-associated infections risk. Subject and methods: This cross-sectional study was conducted among nurses working in the selected government hospitals in Najran City, Saudi Arabia. A self-administered questionnaire was distributed among the targeted nurses using an online survey. The questionnaire includes socio-demographic characteristics such as age, gender, and marital status. The questionnaire had 25 items to measure knowledge, 10 to measure attitude, 6 to measure practices, and 4 to measure the impact of COVID-19 on hand hygiene practices. Results: Among the 386 nurses recruited, 88.3% were females, and 25.6% were aged between 31 to 35 years old. Overall, good knowledge, positive attitude, and good practice levels were found in 42.5, 48.4, and 94%, respectively. The common factor influencing hand hygiene practice was the prevention of cross-infection (88.1%). The total knowledge score mean was 18 ± 3.4 (highest possible score: 25). The total attitude score mean was 37.5 ± 6.1 (highest possible score: 50). The total practice score mean was 26.9 ± 2.8 (highest possible score: 30). A higher score indicates higher KAP of hand hygiene. Factors associated with increased KAP were being older in age (Z = 6.446; p < 0.001), gender female (Z = 9.869; p < 0.001), being a Filipino nurse (H = 117.8; p < 0.001), working in a surgery department (H = 28.37; p < 0.001), having more than 10 years of experience (Z = 6.903; p < 0.001), living in shared accommodation (H = 87.22; p < 0.001), having associated chronic disease (Z = 4.495; p < 0.001), and receiving formal training in hand hygiene (Z = 2.381; p = 0.017). There was a positive highly statistically significant correlation between knowledge score and attitude score (r = 0.556), between knowledge score and practices score (r = 0.303), and between attitude score and practices score (r = 0.481). Conclusion: In light of the results, we can say that the nurses' knowledge, attitude, and practice in regards to hand hygiene were deemed acceptable. We noticed that female nurses who were older and had more experience, as well as those who had received formal hand hygiene training, displayed better KAP compared to their counterparts. Moreover, we found a significant and positive correlation between the scores for knowledge, attitude, and practice. Nonetheless, additional research is necessary to establish the extent of KAP concerning hand hygiene.

An ophthalmologist with myocardial bridging developed takotsubo cardiomyopathy while operating; A case report and literature review.

Key Clinical Message: Healthcare workers are prone to very high level of physical as well as emotional stress that lead to devastating health-related consequences which include but not limited to cardiovascular events that may lead to death. Recognizing the risk of Takotsubo Cardiomyopathy among healthcare worker is the main aim of this report. Abstract: Takotsubo Cardiomyopathy (TC) is a reversible left ventricular wall motion abnormality that could not be explained by coronary artery disease and is typically precipitated by either emotional or physical stress. There is no sufficient data regarding the incidence of TC among healthcare workers and people with myocardial bridging. Here we are describing a case of an ophthalmologist with myocardial bridging who developed TC while in the operation theater.

Predictors of 30-Day Re-admission in Cardiac Patients at Heart Hospital, Qatar.

Background: Cardiovascular disease patients are more likely to be readmitted within 30 days of being discharged alive. This causes an enormous burden on health-care systems in terms of poor care of patients and misutilization of resources. Aims and Objective: This study aims to find out the risk factors associated with 30-day readmission in cardiac patients at Heart Hospital, Qatar. Methods: A total of 10,550 cardiac patients who were discharged alive within 30 days at the heart hospital in Doha, Qatar, from January 2015 and December 2019 were analyzed. The bootstrap method, an internal validation statistical technique, was applied to present representative estimates for the population. Results: Out of the 10,550 cardiac patients, there were 8418 (79.8%) index admissions and 2132 (20.2%) re-admitted at least once within 30 days after the index admission. The re-admissions group was older than the index admission group (65.6 ± 13.2 vs. 56.0 ± 13.5, P = 0.001). Multinomial regression analysis showed that females were 30% more likely to be re-admitted than males (adjusted odds ratio [aOR] 1.30, 95% confidence interval [CI]: 1.11-1.50, P = 0.001). Diabetes (aOR 1.36, 95% CI: 1.20-1.53, P = 0.001), chronic renal failure (aOR 1.93, 95% CI: 1.66-2.24, P = 0.001), previous MI (aOR 3.22, 95% CI: 2.85-3.64, P = 0.001), atrial fibrillation (aOR 2.17, 95% C.I. : 1.10-2.67, P = 0.01), cardiomyopathy (aOR 1.72, 95% CI 1.47-2.02, P = 0.001), and chronic heart failure (aOR 1.56, 95% C.I.: 1.33-1.82, P = 0.001) were also independent predictors for re-admission in the regression model. C-statistics showed these variables could predict 82% accurately hospital readmissions within 30 days after being discharged alive. Conclusion: The model was more than 80% accurate in predicting 30-day readmission after being discharged alive. The presence of five or more risk factors was found to be crucial for readmissions within 30 days. The study may help design interventions that may result in better outcomes with fewer resources in the population.

Smoking in Acute Myocardial Infarction Patients: Observations from a Registry Heart Hospital, Qatar.

Introduction: Studies from the US and Europe showed a decline in smoking among patients with acute myocardial infarction (AMI), but limited data are available from the Middle East. In this study, we describe the temporal trend in the prevalence, associated risk factors, and outcomes of smoking among patients with AMI in Qatar. Materials and Methods: A total of 27,648 AMI patients were analyzed from the cardiology registry at Heart Hospital, Doha, Qatar. This spans from January 1991 to May 2022. Results: Of the total, 13,562 patients (49.1%, 95% confidence interval [CI]: 48%-50%) were smokers, with a clear majority of males (98.5%). Smoking habit was found to decrease in AMI patients with increasing age (age 51-60 years, adjusted odds ratio [OR]: 0.71, 95% CI: 0.67-0.76, P = 0.001, and age ≥61 years, adjusted OR: 0.45, 95% CI: 0.42-0.48, P = 0.001, in comparison to age ≤50 years). Smoking was associated with a lower risk of inhospital mortality (adjusted OR: 0.61, 95% CI: 0.54-0.70, P = 0.001), but triglyceride, obesity, and old myocardial infarction risk factors were associated with a higher risk. A decreasing trend in current smoking habits in each quantile of the 1996-2000 year (adjusted OR: 0.82, 95% CI: 0.71-0.93, P = 0.001), 2001-2005 year (adjusted OR: 0.70, 95% CI: 0.62-0.80, P = 0.001), 2006-2010 year (adjusted OR: 0.75, 95% CI: 0.67-0.84, P = 0.001), 2011-2015 year (adjusted OR: 0.48, 95% CI: 0.42-0.54, P = 0.001), 2016-2020 year (adjusted OR: 0.48, 95% CI: 0.43-0.54, P = 0.001), and ≥2021 year (adjusted OR: 0.46, 95% CI: 0.40-0.53, P = 0.001) was observed in comparison to the quantile 1991-1995 year. Similar results were also observed in the young population (age ≤50 years) including the non-Qataris, who had 25% more smokers in comparison to Qatari nationals. Conclusion: Smoking trended down significantly; however, it remained prevalent in 50% of patients among AMI patients. Smokers were younger, with fewer traditional risk factors, and had lower inhospital mortality.

Self-Medication Related Knowledge, Attitudes, and Practices among Residents of Riyadh, Saudi Arabia: A Community-Based Cross-Sectional Study.

Rational and responsible self-medication (SM) is an essential core element for better health outcomes. It is influenced mainly by the level and adequacy of knowledge, attitude, and appropriateness of practice (KAP) towards SM. The present study explored the level and adequacy of KAP among residents of Riyadh city, Saudi Arabia. A convenient snowball sampling method was utilized to recruit the study participants. Data were analyzed using SPSS version 27. Six hundred and eleven participants completed the questionnaire. Residents with good knowledge, positive attitude, and proper practice were 43.7%, 33.1%, and 90.0%, respectively. The level of KAP was significantly influenced by the participant's occupation, age, gender, nationality, marital status, presence of chronic disease, and COVID-19 infection status. The mean knowledge, attitude, and practice scores observed were 5.11 (SD = 1.27), 22.28 (SD = 2.6) and 5.20 (SD = 1.29), respectively. Pearson correlation and scattered plot matrix analysis revealed a significant positive weak correlation among KAP, indicating that residents with good knowledge possess better attitude (r = 0.142, p < 0.001) and follow the proper practice (r = 0.256, p < 0.001) towards SM. Multivariate linear regression revealed a significant (p < 0.001) negative (ß = -0.059) influence of occupation, family members working in the health sector (p = 0.046, ß= -0.426), Body Mass Index (p = 0.019, ß = -0.049), and physical activity (p = 0.018, ß = -0.292) on the overall KAP score. Understanding the residents' level of KAP towards SM would enable the health care system to identify the gap and develop a mechanism to educate the people and make them knowledgeable about SM and self-care.

Transcatheter Mitral Valve Repair with MitraClip®: A Nationwide Experience.

Background: Transcatheter mitral valve repair (TMVr), using MitraClip®, is a safe and effective procedure for severe mitral valve regurgitation (MR). However, the therapeutic results of MitraClip® in Qatar remain to be elucidated. A total of 25 patients (mean age 60 ± 14.5 years, 64% males) with symptomatic severe MR and prohibitive surgical risks were enrolled in this study. The procedural success rate was 92% to achieve mild residual MR. There was no periprocedural death. All patients experienced significant improvement in heart failure symptoms and MR grade postprocedure with sustained improvement over 1-year follow-up. Conclusion: The TMVr procedure using the MitraClip® device was safe and resulted in meaningful and sustained functional status and echocardiographic parameter improvement.

Acute coronary syndrome and khat herbal amphetamine use: an observational report.

BACKGROUND: The khat plant is a stimulant similar to amphetamine and is thought to induce coronary artery spasm. Khat is widely chewed by individuals originating from the Horn of Africa and the Arabian Peninsula. The aim of this study was to evaluate the clinical characteristics and outcome of khat chewers presenting with acute coronary syndrome. METHODS AND RESULTS: From October 1, 2008, through June, 30, 2009, 7399 consecutive patients with acute coronary syndrome were enrolled in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Nineteen percent of patients were khat chewers; 81% were not. Khat chewers were older, more often male, and less likely to have cardiovascular risk factors. Khat chewers were less likely to have a history of coronary artery disease and more likely to present late and to have higher heart rate and advanced Killip class on admission. Khat chewers were more likely to present with ST-segment-elevation myocardial infarction. Overall, khat chewers had higher risk of death, recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia, and stroke compared with non-khat chewers. After adjustment for baseline variability, khat chewing was found to be an independent risk factor of death and for recurrent ischemia, heart failure, and stroke. CONCLUSIONS: Our data confirm earlier observations of worse in-hospital outcome among acute coronary syndrome patients who chew khat. This worse outcome persists up to 1 year from the index event. This observational report underscores the importance of improving education concerning the cardiovascular risks of khat chewing.