Spontaneous Coronary Artery Dissection: Does Being Unemployed Matter? Insights from the GSCAD Registry.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death. Physical or emotional stressors are the most commonly reported triggers for SCAD. Unemployment has been identified as a source of emotional stress and is linked to poor mental and physical health. OBJECTIVE: To examine the association between employment status and in-hospital and follow-up adverse cardiovascular events in patients with SCAD. METHODS: We conducted a retrospective, multi-center, observational study of patients undergoing coronary angiography for ACS between January 2011 and December 2017. The total number of patients enrolled was 198,000. Patients were diagnosed with SCAD based on angiographic and intravascular imaging modalities whenever available. There were 83 patients identified with SCAD from 30 medical centers in 4 Arab gulf countries. In-hospital (myocardial infarction, percutaneous intervention, ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, internal cardioverter/ defibrillator placement, dissection extension) and follow-up (myocardial infarction, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were compared among those who were employed and those who were not. RESULTS: The median age of patients in the study was 44 (37- 55) years. There were 42 (50.6%) female patients, and 41 (49.4) male patients. Of the cohort, 50 (60%) of the patients were employed and the remaining 33 (40%) were unemployed. 66% of all men were employed and 76% of all women were unemployed. After adjusting for gender unemployment was associated with worse in- -hospital and follow-up cardiac events (adjusted OR 7.1, [1.3, 37.9]), p = 0.021. CONCLUSION: Adverse cardiovascular events were significantly worse for patients with SCAD who were unemployed.

Knowledge, attitude, practices, and behavior regarding COVID-19 among serving personnel of a large military garrison: a quick online cross-sectional survey.

BACKGROUND: There is a deluge of information available and circulated about COVID-19, during the ongoing course of the pandemic. This study was conducted to assess knowledge, attitudes, practices, and behavior regarding COVID-19 among serving soldiers. METHODS: A quick cross-sectional online survey was conducted using a web portal and social media platform, wherein a pretested questionnaire was uploaded. Responses were collected for 3 days. Data were analyzed using Epi Info software. RESULTS: A total of 1231 serving personnel participated in the survey, 133 (10.80%) officers, 144 (11.69%) Junior Commissioned Officers, and 954 (77.49%) Other Ranks. The prevalence of correct knowledge was more than 80% (range 81.47-88.13) except 29.97% regarding transmission by food and water. A statistically significant association (all P values < 0.05) was found with increasing age and education. Social distancing was an effective method as per 93.54%, and 81.38% thought that the response measures were adequate. Handwashing was the only practice which demonstrated a statistically significant association across change in all 3, i.e. age (P = 0.001), education (P = 0.005) and rank (P = 0.022). In the affective domain, increased perception of anxiousness, worriedness, and not feeling relaxed was found in the responses. CONCLUSION: Levels of knowledge, positive attitude, and practice are high among serving soldiers, however feeling of anxiousness and worry prevail. Aggressive, continuous, relevant target population-oriented Information Education and Communication is the need of the hour, with structured and programmed interventions for positive mental health during course of the pandemic and this has been implemented in our area.

The Left Distal Transradial Artery Access for Coronary Angiography and Intervention: A US Experience.

BACKGROUND: The radial artery is the access of choice in many catheterization labs around the world due to its proven benefits over the femoral artery access. There has been growing interest in the left radial artery. We sought to evaluate the feasibility, safety and complication rates of the left distal radial artery (ldTRA) access for cardiac catheterization. METHODS: This is a single arm retrospective study evaluating the feasibility and safety of performing cardiac catheterization through ldTRA. The procedure was completed using standard diagnostic and guiding catheters. Hemostasis was achieved with a radial band. Feasibility was the ability to cannulate the distal left radial artery as well as completing the procedure without requiring an additional arterial access. The safety point included hematoma, bleeding or neuropathy. RESULTS: ldTRA was attempted in 61 patients. 59 patients had successful completion of the procedure through ldTRA. Conversion occurred in 1 patient (1.7%), requiring an additional arterial access to complete the procedure. 34 patients (55.7%) required percutaneous coronary intervention (PCI). There was no access site bleeds post procedure, no hematomas, with 100% successful hemostasis with a radial hemostatic band. There were 2 cases requiring reaccess of the distal left radial artery access for repeat revascularization, with procedure success and good left radial artery patency. CONCLUSION: ldTRA is a safe and feasible arterial access in a radial experienced catheterization lab. ldTRA provides improved operator ergonomics and patient's comfort, in addition to the advantage of being able to cannulate the bypass grafts and with a very low risk of vascular complications.

Triple-Valve Endocarditis in a Diabetic Patient: Case Report and Literature Review.

BACKGROUND: Despite major advancements since its first description in the 19th century, infective endocarditis remains a significant medical challenge. Although commonly involving a single valve, multiple valve involvement may occur, complicating matters even further. Triplevalve endocarditis is a very rare phenomenon. Poorly studied and described only a handful of times in the literature, little is known about the optimal therapeutic and management options in dealing with this complex entity. CONCLUSION: In this paper we describe the case of a 48-year-old male who was diagnosed with triple-valve endocarditis and provide a review of the literature to delineate what is already known and improve our understanding of this rare phenomenon.