Gender Inequity in Cardiovascular Care - Global Perspective.

In the last decades, promotion of women's health has become a growing field for health professionals. Although global society has recognized the importance of providing women with appropriate health services to maintain healthy families and communities, women are still underserved in every segment of health systems worldwide. The inequity in health services for women results from a lack of knowledge, stigma, and social norms for women. This gender inequity exists in every segment of the health system worldwide. In this paper, a review of online global research on an important health issue for women has been conducted. The findings indicate that women with cardiovascular disease are struggling with gender inequity in health services throughout the world. Recommendations for addressing this dilemma require more investment in research into women's health; empowering women to have a role in decision making, and in global collaboration to replicate successful models and programs for women's health.

Chloroquine-resistant Plasmodium falciparum malaria: report of two locally acquired infections in Saudi Arabia.

We report here two cases of Saudi patients who acquired chloroquine-resistant Plasmodium falciparum locally, without any history of foreign travel, blood transfusion, or drug abuse. Both were satisfactorily treated, the first with quinine and a pyrimethamine-sulfadoxine combination, and the other with quinine and tetracycline. These two cases suggest either the possible establishment of chloroquine-resistant P. falciparum in Saudi Arabia, or the beginning of the spread of resistant strains from countries with established resistance to this country. Diligent notification of cases by attending physicians to the Ministry of Health will help to achieve effective control.

Increasing resistance of M. tuberculosis to anti-TB drugs in Saudi Arabia.

The incidence of drug resistance in Mycobacterium tuberculosis (MTB) isolated from our hospital between April 1996 and March 1998 was compared with an earlier study (1993-1995). Thirty (29.7%) of 101 MTB isolates were resistant to one or more anti-TB drugs and 21 (20%) of 101 were multi-drug resistant M. tuberculosis (MDR-TB). Resistance was most common to isoniazid (28.7%), followed by streptomycin (22.8%) and rifampicin (20.8%). Resistance to pyrazinamide and ethambutol was 7.9 and 6.9%, respectively. There was a three-fold increase in resistance compared with the earlier study.

Long-Term outcome of mitral balloon valvotomy in pregnant women.

BACKGROUND AND AIM OF THE STUDY: The study aim was to examine the long-term outcome (nine years) of mitral balloon valvotomy in pregnant patients with severe mitral stenosis. METHODS: Twenty-three patients with severe, symptomatic (NYHA class III/IV) mitral stenosis underwent mitral balloon valvotomy using an Inoue balloon technique during the second trimester of their pregnancy; mean follow up in 19 patients was 5.1 +/- 2.8 years (range: 1 to 9 years). RESULTS: The procedure was successful in all patients. Immediately after valvotomy, the Doppler-derived mitral valve area increased from 0.90 +/- 0.18 to 1.97 +/- 0.36 cm2 (p <0.0001), and the transmitral mean gradient decreased from 15.7 +/- 4.7 to 5.5 +/- 1.6 mmHg (p <0.0001). Four patients had mild worsening of mitral regurgitation, and six developed insignificant interatrial communication immediately after valvotomy. There was no other morbidity or mortality. Patients showed a significant improvement in mean NYHA class, from 3.0 +/- 0.1 to 1.0 +/- 0.02 (p <0.001). Twenty-two patients had normal deliveries; one cesarean section in week 36 resulted in stillbirth. No developmental abnormalities were seen in the babies. At long-term follow up of mothers, the mitral valve area was 1.8 +/- 0.52 cm2; restenosis developed in three patients (16%). One baby died at one week from sudden infant death syndrome, and one at eight months, from pneumonia. All other children showed normal growth, development and speech for their age. CONCLUSION: Mitral balloon valvotomy using the Inoue balloon technique can provide satisfactory immediate relief and long-term outcome in pregnant patients with severe mitral stenosis.

Plasma and urinary selenium in Saudi Arabian patients with dilated cardiomyopathy.

We measured selenium (Se) levels in the urine and blood plasma samples of 72 Saudi Arabian patients with dilated cardiomyopathy (DCM) and 70 control subjects of the same origin. To correct for differences in the hydration state of the subjects, the selenium concentration for each urine sample was normalized by dividing it by the concentration of creatinine (CREAT) in the same sample. The median (and range) of the values found for the concentration of Se in plasma, urine, and normalized concentration in urine for the control subjects was 1.306 (0.66-2.50) microM, 0.478 (0.05-2.00) microM, and 56.7 (10.6-426.5) microM Se/M CREAT, respectively, whereas, for the patients, it was 1.246 (0.53-2.45) microM, 0.39 (0.05-1.90) microM, and 75.1 (4.9-656.2) microM Se/M CREAT, respectively. Additionally, the patients were separated into three subgroups according to the severity of their disease state as judged by NYHA procedure, and were then compared to the control group. Only group 4 (the most severe state of the disease) had a significantly lower concentration of urinary Se than the control group. However, the difference became nonsignificant when normalized for CREAT levels. There was no significant difference in the plasma Se levels between the controls and any of the patient groups. As the plasma Se in the control group and in the DCM patients both fell on the low end of the "normal" range, with the patients being marginally lower than the controls, there is no firm evidence from this study to suggest that Se is related to the high incidence rate of DCM found in Saudi Arabia.

Risk factors for stroke and use of echocardiography in diagnosis: a review.

BACKGROUND: Stroke is a prevalent disease in many communities. Cardiologists consultation and cardiac investigations are frequently requested to rule out cardiac source of embolic manifestations. The heart has been reported to account for 20% of ischaemic strokes in the Western community. OBJECTIVE: To review risk factors for stroke and the use of echocardiography in its diagnosis. METHODS: Medline review was done for reported causes of stroke, these causes were divided into major and minor and were discussed briefly as general physician need to determine when and what to ask for. RESULTS: Some cardiac sources do have established roles in strokes but others have circumstantial and/or secondary roles. CONCLUSION: While there exists evidence to recommend echocardiogram in stroke patients with heart disease, it is not needed routinely in all patients with stroke. In some circumstances, echocardiography may enhance the diagnosis but not necessarily change management [corrected].

Idiopathic hypereosinophilic syndrome: a report of four cases in Arabs, and a review of the literature.

We report four Arab patients with idiopathic hypereosinophilic syndrome (IHES). They presented with varied clinical pictures simulating chronic inflammatory bowel disease (IBD), pulmonary tuberculosis (TB), meningioma, peripheral neuropathy, and infective endocarditis (IE). All had significant peripheral and bone marrow eosinophilia, histological confirmation of eosinophilic infiltration of multiple organs, and clinical evidence of multi-organ dysfunction. Extensive laboratory investigations excluded other possible causes of eosinophilia. All were treated with steroids, with complete response in two. Two others were treated additionally with hydroxyurea, and one with methotrexate, cyclophosphamide, vincristine and alpha-interferon. The pathogenesis, varied clinical, laboratory, and histopathological features, and the management of IHES are reviewed.

The role of selenium deficiency in dilated cardiomyopathy in Saudi Arabia.

BACKGROUND: Selenium deficiency is implicated in the etiology of endemic juvenile dilated cardiomyopathy in China, and in sporadic cases in other countries. The aim of this study was to evaluate the role of selenium deficiency in the pathophysiology of dilated cardiomyopathy in the Saudi Arabian population. PATIENTS AND METHODS: Plasma and urine selenium concentrations from 72 Saudi patients with confirmed dilated cardiomyopathy were compared with corresponding values from 70 control subjects of the same national origin who had normal ventricular function. RESULTS: Plasma and urine selenium concentrations (mean+/-SD) were 1.347plusmn;0.45 and 0.49+/-0.37 micromol/L, respectively, for the patient group, and 1.32+/-0.41 and 0.60+/-0.41 micromol/L, respectively, for the control group. The differences in the values between the two groups were statistically insignificant. CONCLUSION: In the Saudi population, dilated cardiomyopathy is not caused by selenium deficiency.

Arrhythmogenic right ventricular dysplasia.

Right ventricular dysplasia (RVD) is a disease entity of unknown cause that is characterised by partial or total replacement of RV-muscle by adipose or fibrous tissue. It is a well-recognized cause of arrhythmia and premature sudden death, but usually underdiagnosed. Several noninvasive and invasive diagnostic modalities have been used, however, all may not be positive in a given case. Drug therapy with class 1c, beta-blocker, and amiodarone in variable combination produce varying success rates in preventing recurrent ventricular tachycardia. Failure of the above measures calls for insertion of implantable cardioverter defibrillator. The attention of emergency physicians is drown to this disease as they are the first medical personnel to be presented with this disease as an emergency. Hence their recognition of RVD will ensure early and proper management.