The outcome of heart failure in women: a study from a tertiary heart function clinic.

BACKGROUND: Women have unique risk factors for heart disease and a higher risk of cardiovascular mortality. Heart failure (HF) prevalence in women is affected by age, pregnancy, and menopause. More understanding of HF etiology, management, and outcome in women is needed. METHOD: a retrospective study of women diagnosed with HF following at a heart function clinic (HFC) in a tertiary cardiac center. RESULTS: A total of 1988 HF patients were screened. Women accounted for 561 (28.2%). The mean age at first HF presentation was 47.7 ± 17.9 years. The most common diagnosis was HF with reduced ejection fraction (HFrEF ≤ 40%) 473 (84%). The most frequent cause of HF was dilated cardiomyopathy (DCM) in 304 patients (54.2%). Prevalence of diabetes (DM) was 272 (48.5%), hypertension (HTN) 267 (47.6%), and body mass index (BMI) ≥ 30 was 332 (59%). Adverse pregnancy events included miscarriages 151 (38.6%), preeclampsia 15 (3.8%), and spontaneous coronary dissection 3 (0.8%). Left ventricle recovery to EF ≥ 50% occurred in 116 (20.7%) patients, while death occurred in 32 (5.7%) patients during follow-up. Women living with chronic HF were 240 (42.8%). The use of beta-blockers occurred in (96%), renin-angiotensin enzyme inhibitors (86.6%), mineralocorticoids (55.4%), and sodium-glucose cotransporter 2 inhibitors (31.6%). Women who had a heart transplant were 19 (3.75%). CONCLUSION: Referral to specialized heart function clinics remains low for women. There is high burden of obesity among women and the majority of women have chronic HF but advanced HF therapy consideration is low in women.

Sustained low efficiency dialysis is non-inferior to continuous renal replacement therapy in critically ill patients with acute kidney injury: A comparative meta-analysis.

BACKGROUND: Critically ill adults with acute kidney injury (AKI) experience considerable morbidity and mortality. This systematic review aimed to compare the effectiveness of continuous renal replacement therapy (CCRT) versus sustained low efficiency dialysis (SLED) for individuals with AKI. METHODS: We carried out a systematic search of existing databases according to standard methods and random effects models were used to generate the overall estimate. Heterogeneity coefficient was also calculated for each outcome measure. RESULTS: Eleven studies having 1160 patients with AKI were included in the analyses. Meta-analysis results indicated that there was no statistically significant difference between SLED versus continuous renal replacement therapy (CRRT) in our primary outcomes, like mortality rate (rate ratio [RR] 0.67, 95% confidence interval [CI] 0.44-1.00; P = .05), renal recovery (RR 1.08, 95% CI 0.83-1.42; P = .56), and dialysis dependence (RR = 1.03, 95% CI 0.69-1.53; P = .89). Also, no statistically significant difference was observed for between SLED versus CRRT in the secondary outcomes: that is, length of intensive care unit stay (mean difference -0.16, 95% CI -0.56-0.22; P = .41) and fluid removal rate (mean difference -0.24, 95% CI -0.72-0.24; P = .32). The summary mean difference indicated that there was a significant difference in the serum phosphate clearance among patients treated with SLED and CRRT (mean difference -1.17, 95% CI -1.90 to -0.44, P = .002). CONCLUSIONS: The analysis indicate that there was no major advantage of using continuous renal replacement compared with sustained low efficiency dialysis in hemodynamically unstable AKI patients. Both modalities are equally safe and effective in treating AKI among critically ill patients.

Understanding the Knowledge and Attitude of Prehospital Sepsis Care among Emergency Medical Service Personnel.

BACKGROUND: Sepsis represents a huge burden for the health-care system. Septic patients presented by emergency medical services (EMS) are usually sicker in comparison to patients arriving by other means. Knowledge of sepsis is a key factor in recognizing and providing the appropriate care; it is not the only barrier as EMS providers do not have access to the proper diagnostic investigation. This work highlighted the level of knowledge, awareness, and attitude of EMS providers regarding prehospital care of sepsis in Riyadh, Saudi Arabia. METHODS: This study was a cross-sectional study that conducted among EMS personnel of Saudi Red Crescent Authority and King Abdulaziz Medical City. One hundred and ninety-seven individuals were sampled (99 were technicians and 98 were paramedics). RESULTS: Most participants (71%) were aware of the term "sepsis;" however, only 48% of participants correctly defined sepsis (30% between emergency medical technicians [EMTs] vs. 66% paramedics group, P < 0.01). Paramedics were noted to have a better understanding of signs, symptoms, and management of sepsis. Most of the participants thought that sepsis can be identified during prehospital care (55%) and 75% suggested that they should be involved in the management of septic patients. About 80% responded that their intervention would result in a better outcome for patients and would influence the behavior of emergency department medical care. Most of the participants (83%) were willing to be actively engaged in the prehospital care of septic patients. CONCLUSION: This study showed an insufficient level of knowledge and awareness regarding sepsis care in the EMS field in Saudi Arabia. Paramedics had more knowledge and awareness about sepsis care compared to EMT personnel. Future work should focus on exploring the reasons behind this, as well as implementing plans to improve education about sepsis for EMS personnel.

Improving pediatric emergency department physicians' adherence to clinical practice guidelines on the diagnosis and management of group A beta-hemolytic streptococcal pharyngitis-a cross-sectional study.

INTRODUCTION: Pharyngitis is one of the major and commonly seen presentations in pediatric emergency departments. While it could be caused by both bacterial and viral pathogens, antibiotics are improperly prescribed regardless of the pathogen. Inappropriate usage of antibiotics has risen the concern of microbial resistance and the need for stricter guidelines. Many guidelines have been validated for this reason, and the Centor score (Modified/McIsaac) is most commonly implemented. This study aims to assess the adherence and enumerate the reasons behind the suboptimal adherence to guidelines (Centor/McIsaac score) of pediatric emergency department physicians in the diagnosis and management of GABHS pharyngitis to lay the groundwork for future actions and to employ educational programs and implement local guidelines for the prevention of the development of multi-drug resistant microorganisms. METHODOLOGY: We surveyed pediatric emergency department physicians of ten teaching hospitals of Riyadh, Saudi Arabia. We used convenient sampling and estimated a sample size of 170 physicians, and interns and medical centers without pediatric emergency department were excluded from the study. Elements of the Centor score (Modified/McIsaac) were used as a part of the assessment of physicians' knowledge of the guidelines. Adherence was assessed by requiring the participants to answer questions regarding their usage of diagnostic means when they suspect a bacterial cause of pharyngitis, as recommended by the guidelines. RESULTS: A total of 243 physicians answered the questionnaire, 43 consultants (17.6%) and 200 non-consultants (82.4%). On the knowledge score, 9.1% scored 0, and the majority of both groups, 46.5%, earned a score of 1. The remainder 44.4%, earned a score of 2. Adherence to guidelines was defined as when diagnostic tests (throat culture or rapid antigen detection test) were always requested prior to prescribing antibiotics when acute bacterial pharyngitis was suspected. Only 27.3% (n = 67) of our sample are adherent to guidelines, whereas the majority, 72.7% (n = 175), are non-adherent. Several factors were assessed as reasons for lack of adherence. CONCLUSION: Lack of knowledge and adherence to guidelines is prevalent in our setting, with awareness, knowledge, and behavior of physicians playing as major factors behind this low adherence. Studies should aim towards the assessment of adherence towards locally developed guidelines.