Acinetobacter Infections among Adult Patients in Qatar: A 2-Year Hospital-Based Study.

This retrospective study was conducted at Hamad General Hospital, Qatar, to describe the demographic data, clinical features underlying diseases, antimicrobial susceptibility, and outcome of A. baumannii infection. It involved all adult patients 15 years of age or older who were managed at Hamad General Hospital for A. baumannii infection from January 1, 2012, to December 31, 2013. We identified a total of 239 patients with A. baumannii infection, of which 182 (76.2%) were males. The mean age was 49.10 ± 19.57 years. The majority of the episodes (25.1%) occurred in elderly patients (≥65 years) and the most commonly identified site of A. baumannii infection was the respiratory tract, 117 (48.9%). Most episodes of infection, 231 (96.7%), were hospital-acquired and high rate of nosocomial infections occurred in the medical intensive care unit, 66 (28.6%). All patients had underlying medical conditions. Maximum resistance was seen to cefotaxime, 147 (58.3%), and minimum resistance was seen to colistin, 2 (1.4%). Of the 239 isolates, 102 (42.7%) were susceptible and 137 (57.3%) were multidrug-resistant. The in-hospital mortality in our study was 31%. Male gender, multidrug resistance, and septic shock were found to be independent mortality predictors.

Incidence of hypoglycaemia in patients with type-2 diabetes taking multiple glucose lowering therapies during Ramadan: the PROFAST Ramadan Study.

OBJECTIVE: To assess the incidence of hypoglycemia in people with type-2 diabetes mellitus (T2DM) on three or more anti-diabetic medications during Ramadan. STUDY DESIGN METHODS: We have studied people with T2DM on three or more glucose-lowering drugs during Ramadan of H1438 (May-June 2017). The dose of each drug was adjusted according to a pre-specified protocol. The incidence of symptomatic or blood glucose confirmed hypoglycemia was recorded during the study. RESULTS: We enrolled 228 people with T2DM; 181 completed the study, and data on hypoglycaemia was available in 172 subjects. There were 115 males and 66 females, (mean age ± SD) 53.6 ± 9.7 years, diabetes duration 10 ± 6 yrs. The incidence of hypoglycaemia was 16.3% (28/172). Univariable logistic regression analysis showed that the risk of hypoglycaemia was increased in Arab subjects compared to Qatari; in those with longer duration of diabetes; and in those on four or more anti-diabetic medications compared to those on three anti-diabetic medications. CONCLUSION: Despite the tailored advice, there is a high incidence of hypoglycemia in people with T2DM taking multiple glucose lowering therapies whilst fasting during Ramadan. Guidelines should address the increased complexity in anti-diabetic medications in patients who fast during Ramadan. Healthcare providers should individualize the modifications in anti-diabetic medications during Ramadan.

The influence of female gender on cardiac arrest outcomes: a systematic review of the literature.

BACKGROUND: Sudden cardiac arrest is an important cause of cardiovascular mortality. The impact of gender on the outcome of cardiac arrest is not clear and data about that is limited. OBJECTIVE: Understanding the influence of gender on cardiac arrest through a systematic review of the published literature. METHODS: A search of all published studies in English between January 1970 and May 2013 was performed using the electronic databases PubMed and MEDLINE, using the key words 'cardiac arrest', 'outcome', and 'gender'. RESULTS: Eleven studies were included in this review, all of which were observational studies conducted using national-based database registries of cardiac arrest. A total of 548,440 patients were enrolled in these studies with 220,646 (40.3%) of them being female patients. In general, there was a lower percentage of women in the reported studies compared to men. Women were older in age and more likely to have non-shockable rhythms as the initial rhythm. Women also had a lower rate of witnessed arrest, a lower rate of bystander resuscitation, a higher rate of survival until hospital admission and a lower rate of in-hospital survival compared to men. Women also had a more favorable one month survival and neurological outcome. CONCLUSION: In the reported literature female gender seems to offer survival and outcome advantages following out-of-hospital cardiac arrest over male gender. This is in contrast to most other aspects of heart disease in which women tend to have a worse prognosis.

Anticoagulation in atrial fibrillation and co-existent chronic kidney disease: efficacy versus safety.

INTRODUCTION: Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are individually associated with a higher incidence of stroke as compared with the general population. Over the last two decades, an increase in prevalence of AF is seen in patients with CKD. While long-term anticoagulation with warfarin is well established to reduce the risk of thromboembolic event in patients with AF, its safety and efficacy has not been documented in patients with severe CKD. AREAS COVERED: In this review, the authors analyze the risk and benefit of long term anticoagulation across the spectrum of AF patients with CKD and explore the role of novel agents in this unique patient population. A Medline search of the English literature published between 1980 and 2012 was performed using the heading 'chronic kidney disease' combined with 'atrial fibrillation', 'hemodialysis', 'warfarin', 'anticoagulation' and 'new oral anticoagulants'. EXPERT OPINION: Long-term anticoagulation with warfarin under strict monitoring appears to be the cornerstone of therapy in patients with CKD to prevent stroke. Further research is warranted to explore the safety and efficacy of newer anticoagulant agents in these high-risk patients in order to reduce the incidence of disabling stroke.

Impact of religious Ramadan fasting on cardiovascular disease: a systematic review of the literature.

BACKGROUND: Fasting during the month of Ramadan is a religious obligation that is practiced by millions of people around the world yet there is no clear scientific consensus on its effects on cardiovascular disease. This study was performed to inform physicians as well as patients of evidence based recommendations on this subject. AIM: The study was undertaken to assess: (1) any alteration in the incidence of acute cardiac illness during Ramadan fasting; (2) whether fasting during the month of Ramadan alters the clinical status of patients with stable cardiac disease; and (3) the impact of Ramadan fasting on cardiovascular risk factors in normal subjects, in patients with stable cardiac disease, metabolic syndrome, dyslipidemia, type 2 diabetes and systemic hypertension. STUDY DESIGN: Systematic review of the literature. METHOD: A Medline search of the English literature published between January 1980 and September 2012. RESULTS: The incidence of acute cardiac illness during Ramadan fasting was similar to non-fasting days, although the timing of symptom onset may be different, with significant increase in events during the period of 'breaking fast' when compared to non-fasting days. The majority of patients with stable cardiac illness can undergo Ramadan fasting without any clinical deterioration. Body mass index, lipid profile, and blood pressure showed significant improvement in normal healthy subjects, patients with stable cardiac illness, metabolic syndrome, dyslipidemia and hypertension during Ramadan fasting. The lipid profile of diabetic patients deteriorated significantly during Ramadan fasting. CONCLUSIONS: Ramadan fasting is not associated with any change in incidence of acute cardiac illness and the majority of cardiac patients can fast without any difficulty. Improvement in lipid profile, especially 30% to 40% increment in high-density lipoprotein, as reported in some studies, appear promising. Diabetic patients should be carefully monitored during Ramadan fasting.