Perception of general pediatricians in Riyadh towards vaccination of patients with congenital heart diseases.

BACKGROUND: Congenital heart defected (CHD) children are often predisposed to numerous conditions ranging from arrythmias, infections, to heart failure. Proper implementation of vaccination plan and multidisciplinary acts are mandatory for maintaining such cases to reduce the mortality and morbidity. Furthermore, CHD are also at risk of vaccine adverse reaction and several blooddisseminated pathogens infections, and at risk of death if such events where to occur. Perception and Interpretation of the knowledge and experience of general pediatricians towards vaccination of patients with congenital heart diseases is a crucial element to understand, and to improve healthcare practice in Riyadh, Saudi Arabia. AIMS: To clarify, our aim is to investigate views of different pediatricians in vaccination plans, to perceive junior and senior pediatricians, and to identify extra vaccines given to children with a congenital heart defect. SETTINGS AND DESIGN: This study is a cross-sectional study that includes the distribution of 246 questionnaires through personal interview focusing on pediatric cardiologists and general pediatricians with varying years of practice and degrees. Study was conducted by six medical interns: Mohammed O. Alfakhri, Meshal F. Alhajji, Abdulrahman M. Alyani, Yahya Z. Murad, Abdulrahman E. Alghannam, Alwaleed H. Algahtani, in six different teritiary hospitals, King Abdulaziz Medical City (KAMC), King Fahad Medical City (KFMC), King Faisal Specialist Hospital (KFSH), King Salman Hospital, and Alyamamah Hospital, in Riyadh, Saudi Arabia. METHODS AND MATERIAL: Data was collected through a convenient sampling technique and was analyzed using SPSS (version 20) and rearranged to observe the most frequent information obtained from the questionnaire. STATISTICAL ANALYSIS USED: Categorical study was described in frequencies and bar charts. Chi-Square test of significance was used after the data entry to assess the significance of the values obtained. RESULTS AND CONCLUSIONS: There was no significant difference between the six hospitals. In the following study, 81.7% of the participants believe that patients with congenital heart diseases are combined immunodeficient, and 84.6% agreed on giving special\extra vaccine with no preference over live and\or killed vaccine. On top of that, participants believe that the extra vaccines given to congenital heart disease patients with combined immunodeficiency are meningococcal and pneumococcal vaccines, and the special vaccine given to them are respiratory syncytial virus (RSV) and influenza vaccine. To conclude, congenitally heart defected children are widespread worldwide. Children suffering from the disease are having a serious problem that affects their lives from its earliest. For that, our research mainly focuses on improving their lives by trying to reduce the effect of several other preventable diseases using vaccines as and when they need. Several other studies believed in giving extra/special vaccines that vary depending on the location of the study. However, in Riyadh, we found that most pediatricians agree on giving extra vaccines as meningococcal and pneumococcal, and RSV and influenza as special vaccines to children with congenital heart defects.

Cellular expression of renal, cardiac and pulmonary inducible nitric oxide synthase in double-transgenic mice expressing human renin and angiotensinogen genes.

1. Hypertensive mice expressing the human renin (REN) and angiotensinogen (AGT) genes are used as a model for human hypertension. 2. The aim of the present study was to investigate the cellular expression and distribution of inducible nitric oxide synthase (iNOS) using immunohistochemistry in lung, heart and kidney tissues from a model of human hypertension using male and female double-transgenic (h-Ang 204/1h-Ren6) mice and wild-type C57/BI6J mice as controls. 3. In the kidney, the pattern of iNOS expression in various renal microanatomical regions during hypertension was similar to that of age-matched controls, except in the medullary ascending limb (MAL). In hypertension, iNOS expression was downregulated in the MAL. No significant differences in iNOS expression were seen between control or hypertensive mice in various cardiac microanatomical locations. In the lungs of hypertensive mice, iNOS expression was upregulated in bronchial airway epithelium and bronchial and vascular smooth muscle cells, but downregulated in alveolar macrophages, alveolar septa and pulmonary vascular endothelial cells. Expression of iNOS was similar between male and female mice in the kidney, heart and lungs. 4. In conclusion, iNOS regulation in hypertension is complex and depends on the cell type in which it is expressed and the localization of the cell type in the cardiorenal and pulmonary systems.

A critical review of the use of carvedilol in ischemic heart disease.

ß-Adrenergic receptor antagonists (ß-blockers) have been recognized for their cardioprotective properties, prompting use of these pharmacologic agents to become more mainstream in acute myocardial infarction (AMI) and congestive heart failure (CHF). Despite their popularity as a class, the ability to protect the myocardium varies significantly between different agents. Carvedilol is a non-selective ß-blocker with α1-adrenergic receptor antagonism properties. It is unique among ß-blockers because in addition to improving exercise tolerance and its anti-ischemic properties secondary to a reduction in heart rate and myocardial contractility, carvedilol exerts other beneficial effects including: antioxidant effects; reduction in neutrophil infiltration; apoptosis inhibition; reduction of vascular smooth muscle migration; and improvement of myocardial remodeling post-AMI. These properties, documented in animal models and subsequent clinical trials, are consistent with established evidence demonstrating decreased morbidity and mortality in patients with CHF and post-AMI. This article reviews the role of carvedilol compared with other ß-blockers in the treatment of CHF and post-AMI management.

Inflammatory bowel disease in the geriatric population.

Inflammatory bowel disease (IBD) is a chronic disease that affects not only the young adults, but also the elderly. The elderly are more vulnerable and at higher risk from complications related to IBD. In this review we focus on IBD important features in the elderly and discuss the disease (1) epidemiology, (2) pathophysiology, (3) clinical manifestations and diagnosis, (4) prognosis, (6) therapy and (7) potential future research directions.

Peripartum cardiomyopathy: a comprehensive review.

Peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular dysfunction and symptoms of heart failure occur in the peripartum period in previously healthy women. Incidence of PPCM ranges from 1 in 1300 to 1 in 15,000 pregnancies. The etiology of PPCM is unknown, but viral, autoimmune, and idiopathic causes may contribute. The diagnostic criteria are onset of heart failure in the last month of pregnancy or in first 5 months postpartum, absence of determinable cause for cardiac failure, and absence of a demonstrable heart disease before the last month of pregnancy. Risk factors for PPCM include advanced maternal age, multiparity, African race, twinning, gestational hypertension, and long-term tocolysis. The clinical presentation of patients with PPCM is similar to that of patients with dilated cardiomyopathy. Early diagnosis and initiation of treatment are essential to optimize pregnancy outcome. Treatment is similar to medical therapy for other forms of dilated cardiomyopathy. About half the patients of PPCM recover without complications. The prognosis is poor in patients with persistent cardiomyopathy. Persistence of disease after 6 months indicates irreversible cardiomyopathy and portends worse survival.