Steroids and myocardial infarction: Investigating safety and short-term mortality in critical post-myocardial infarction patients.

BACKGROUND: Conventionally, in the pre-percutaneous intervention era, free wall rupture is reported to be a major concern for using steroids in myocardial infarction (MI) patients. Therefore, the aim of this study was to evaluate the safety of the use of steroids in critically ill post-MI patients in terms of hospital course and short-term (up to 180-day) mortality. METHODS: We included patients admitted to CCU diagnosed with MI, undergone revascularization, critically ill, and requiring mechanical ventilator (MV) support. The hospital course and short-term (up to 180-day) mortality were independently compared between steroid and non-steroid cohorts and propensity-matched non-steroid cohorts. RESULTS: A total of 312 patients were included, out of which steroids were used in 93 (29.8%) patients during their management. On periodic bedside echocardiography, no free wall rupture was documented in the steroid or non-steroid cohort. When compared steroids with a propensity-matched non-steroid cohort, MV duration >24 h was 66.7% vs. 59.1%; p = 0.288, major bleeding was 6.5% vs. 3.2%; p = 0.305, need for renal replacement therapy was 9.7% vs. 8.6%; p = 0.799, in-hospital mortality was 35.5% vs. 23.7%; p = 0.077, and 180-day mortality was 48.4% vs. 41.9%; p = 0.377, respectively. The hazard ratio was 1.22 [95% CI: 0.80 to 1.88] compared to the propensity-matched non-steroid cohort. The ejection fraction (%) was found to be the independent predictor of 180-day mortality with an adjusted odds ratio of 0.92 [95% CI: 0.86 to 0.98]. CONCLUSIONS: In conclusion, using steroids is safe in post-MI patients with no significant increase in short-term mortality risk.

Assessment of Quality of Life in Bronchial Asthma Patients.

Introduction Asthma, a well-known chronic respiratory disease, is common worldwide. This study aimed to assess the quality of life in bronchial asthma patients and to determine the factors leading to poor quality of life among these patients. Materials and methods A cross-sectional study was conducted at a public sector hospital. The sample size was calculated as 134, with a nonprobability consecutive sampling technique. The Ethical Review Committee approved the study protocol. Demographic and asthma quality of life data were collected via a questionnaire. Data were analyzed IBM SPSS Statistics for Windows, Version 19.0 (Armonk, NY: IBM Corp.). Multivariate logistic regression was performed to observed the effect of these variables on the poor quality of life. A regression coefficient and odds ratio with a confidence interval of 95% and P-value ≤ .05 were taken as significant. Results The average age of patients was 40.6 ± 9.5 years. In this study, 96 of 134 patients (71.4%) with bronchial asthma reported a poor quality of life. In the univariate analysis, advanced age (≥ 40 years), obesity, being female, family history of asthma, pets at home, and moderate severity of asthma significantly contributed to poor quality of life. Multivariate logistic regression was performed, and it was observed that advanced age (≥ 40 years), being female, a pet at home, and moderate severity of asthma were four to 13 times more likely to predict a poor quality of life for patients with bronchial asthma. Conclusions The severity of asthma significantly contributed to poor quality of life. Health facilitators should look into the causes of such risk to increase the perception of health-related quality of life (HRQoL) among asthma patients.

Almond supplementation reduces serum uric acid in coronary artery disease patients: a randomized controlled trial.

OBJECTIVE: Elevated serum uric acid (UA), a biomarker of renal insufficiency, is also an independent prognostic marker for morbidity in coronary artery disease (CAD) and poses serious health risks. This study reports the effect of almond consumption on UA in CAD patients. STUDY DESIGN: A randomized controlled clinical trial was conducted with three groups: no-intervention (NI), Pakistani almonds (PA) or American almonds (AA). Patients were recruited from the Cardiology Clinics, Aga Khan University Hospital. Two follow-ups were scheduled at week-6 and week-12. 150 patients were randomly divided in three groups (50 per group). NI was not given almonds, whereas the PA and AA were given Pakistani and American almond varieties (10 g/day), respectively; with instruction to soak overnight and eat before breakfast. RESULTS: Almonds supplementation significantly reduced (p < 0.05) serum UA among groups, and over time. At week-6, UA concentrations were -13 to -16 % less in PA and AA; at week-12 the concentrations were -14 to -18 % less, compared to NI. Systolic and diastolic blood pressure and body weights of the participants remained fairly constant among all the groups. CONCLUSION: Almonds (10 g/day), eaten before breakfast, reduces serum UA in CAD patients. Prevention of hyperuricemia can confer protection from kidney and vascular damage and if extrapolated for general population, dietary almonds can offer grander health benefit. Trial is registered at Australian New Zealand Clinical trial registry as ACTRN12614000036617.