RESUMO
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in clinical practice and is a common comorbidity in hemodialysis patients. AF contributes to cardiovascular complications; therefore, it is recommended to screen for AF in high-risk patients to prevent serious complications. As we currently lack a handy AF screening tool, the aim of this study was to assess the accuracy of a modified BP monitor (Omron M6), in detecting AF in hemodialysis patients. In a cross-sectional analysis conducted from October 2018 to February 2019, we enrolled all the hemodialysis patients, older than 18 years and maintained on hemodialysis for at least 3 months in four hemodialysis centers in Jordan. Logistic regression was used to predict the accuracy, while the R package (epiR) was used to determine the sensitivity and specificity of the Omron M6 in screening AF. A total of 227 patients participated in the study, with a median age of 57 years (42.8-67.3); among these, 44.5% were female. Of all the participants, 18 were detected with AF, which was confirmed by a 12-lead ECG. The prevalence of AF in our study was 7.9%, while the sensitivity, specificity and accuracy of the Omron M6 in detecting AF were calculated as 83.0% (95% CI, 59.0-96.0), 94.0% (95% CI, 90.0-97.0) and 93.4% (95% CI, 88.0-95.0) respectively. We concluded that Omron M6 has high sensitivity, specificity, and accuracy in screening AF among hemodialysis patients. However, further studies are required to ascertain and firmly establish this preliminary finding.
Assuntos
Fibrilação Atrial , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Pressão Sanguínea , Estudos Transversais , Eletrocardiografia , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Diálise Renal/efeitos adversosRESUMO
To reduce the need for elevated electrical potential to deactivate catechol-based smart adhesive and preserve its reversibility, conductive 1-pyrenemethyl methacrylate (PyMA) was incorporated into a catechol and phenylboronic acid-containing adhesive coating immobilized on aluminum (Al) discs. Electrochemical impedance spectroscopy (EIS) indicated that incorporation of 26 mol % of PyMA reduced ionic resistance (Rs) and charge-transfer resistance (Rc) of the coating from over 22 Ω/mm2 to 5.9 and 1.2 Ω/mm2, respectively. A custom-built Johnson-Kendall-Roberts (JKR) contact mechanics test setup was used to evaluate the adhesive property of the coating with in situ applied electricity using a titanium (Ti) sphere both as a test substrate as well as the cathode for application of electricity and the Al disc as the anode. The adhesive coating demonstrated over 95% reduction in the adhesive property when electricity (1-2 V) was applied while the adhesive was in direct contact with the Ti surface. The addition of PyMA enables the deactivation of the adhesive using a voltage as low as 1 V. Both cyclic voltammetry (CV) and attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectra confirmed the formation of catechol-boronate complexation through electrochemical stimulation. Breaking the complex with an acidic buffer (pH 3) recovered the catechol for strong wet adhesion and the coating could be repeatedly deactivated and reactivated using low electrical potential for up to five cycles. Incorporation of both conductive PyMA and boronic acid as the temporary protecting group was required to achieve rapidly switchable adhesive that could be deactivated with low applied voltage.
Assuntos
Adesivos , Catecóis , Eletrodos , TitânioRESUMO
BACKGROUND: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia worldwide and it aggravates cardiovascular morbidity and mortality; however, this is largely under-diagnosed. Moreover, among end-stage renal disease patients on haemodialysis, AF is substantially more common and serious. The researchers conducted this study to assess the prevalence of, and the factors correlated with AF in Jordanian haemodialysis patients. METHODS: In a cross-sectional analysis conducted from October 2018 to February 2019 in four tertiary hospitals, the researchers enrolled all consenting patients aged 18 years or older who were on haemodialysis for at least three months prior to the study. We screened for AF clinically by pulse palpation, precordial auscultation, by an automated blood pressure monitor and an electrocardiogram. The researchers reported qualitative variables as counts and frequencies, while continuous variables were summarised using the mean or median where necessary. We used multiple logistic regression with backward selection to identify independent risk factors of AF. RESULTS: A total of 231 patients were enrolled; mean age was 54.8 ± 15.6 years (from 20 to 86), and 44.3% of them were women. The prevalence of AF was found to be 7.8% (95% CI, 4.8-12.2), with no gender disparity. Age (adjusted odds ratio [AOR] = 1.05; 95% CI, 1.01-1.10; p = 0.031), history of ischaemic heart disease (AOR = 3.74; 95% CI, 1.09-12.34; p = 0.033), history of smoking (AOR = 0.15; 95% CI, 0.02-0.60; p = 0.019), and low interdialytic weight gain (AOR = 0.50: 95% CI, 0.25-0.91; p = 0.031) were independently correlated to AF. CONCLUSIONS: The prevalence of AF among patients on maintenance haemodialysis is high, but largely undiagnosed. AF is generally associated with advancing age, history of ischaemic heart disease, lower interdialytic weight gain, and history of smoking. We suggest routine check-up of AF in this high-risk group of patients as anticoagulant therapy if indicated may prevent serious complications. However, there is a need for large-scale cohort studies and for the creation of regional chronic kidney disease and dialysis registries in the Middle East region.
Assuntos
Fibrilação Atrial/epidemiologia , Falência Renal Crônica/terapia , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Estudos Transversais , Feminino , Humanos , Jordânia/epidemiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Adulto JovemRESUMO
There is no agreement on the involvement of angiotensin II type 1 receptor (AT1R) gene A(1166)C variant and essential hypertension. The purpose of this study was to investigate the association between angiotensin II type 1 receptor (AT1R) gene A(1166)C variants with essential hypertension and some related parameters in a sample of Jordanian hypertensive patients. DNA samples from 108 hypertensive individuals and 102 age- and gender-matched non-hypertensive controls of the Jordanian population were analyzed by polymerase chain reaction followed by restriction fragment length polymorphism assay (PCR-RFLP) methods to determine the frequency of A(1166)C variants alleles. No statistically significant differences were found in the distribution of alleles and genotypes between hypertensive and non-hypertensive individuals, not even after gender segregation. The frequency of the variant allele (C(1166)) was significantly higher in the early-onset compared to the late-onset group of hypertensive males, in subjects with positive family history of hypertension, and in subjects with high waist circumference. In conclusion, the A(1166)C polymorphism is not associated with essential hypertension in Jordanian hypertensive individuals. However, it was associated with an early onset of hypertension in males, with positive family history of hypertension, and with high waist circumference irrespective of blood pressure status.
Assuntos
Pressão Sanguínea/genética , Predisposição Genética para Doença , Hipertensão/genética , Polimorfismo de Nucleotídeo Único , Receptor Tipo 1 de Angiotensina/genética , Adulto , Idade de Início , Idoso , Hipertensão Essencial , Feminino , Genótipo , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Circunferência da CinturaRESUMO
BACKGROUND: Self-efficacy is an important factor associated with healthy lifestyle changes in heart failure treatment. Functional capacity testing of heart failure patients (HFPs) can stratify prognosis. Reduced functional capacities in HFPs are linked to a poor heart failure prognosis. Limited research has examined the potential relationship between self-efficacy and functional capacity. AIM: The aims of this study were to assess self-efficacy level and functional capacity among HFPs after hospitalization, and examine whether there is a relationship between them. METHODS: A descriptive correlational design was used. A convenience sample of 220 HFPs was recruited from 2 hospitals in Jordan. The Arabic version of Cardiac Self-Efficacy Questionnaire was used to assess self-efficacy, the 6-Minute Walking Test (6-MWT) was used to assess functional capacity, and the Borg rating of perceived exertion scale (Borg Scale) was used to assess exertion during 6-MWT. RESULT: The sample included 46.8% male (n = 103) and 53.2% female (n = 117). The mean age was 52.66 ± 8.91 years. Most of the HFPs were categorized based on New York Heart Association classification as class I, 35.9% (n = 79), and class II, 41.4% (n = 91). The mean ejection fraction was 41.46 ± 9.44. The global self-efficacy was moderate (32.98 ± 9.92), and the mean score for the 6-MWT was 494.35 ± 143.37. The Borg Scale mean was 10.94 ± 3.34. In addition, there was a positive relationship between self-efficacy and 6-MWT (r = 0.63, n = 220, P = .01). CONCLUSION: This study provides baseline data for further research on treatment of HFPs, and the development of evidence-based tailored health interventions to maintain and improve self-efficacy and functional capacity among these service users. Moreover, replicated researches can test the study results considering different methodologies, such as using objective functional capacity tool and longer follow-up periods.
Assuntos
Teste de Esforço , Insuficiência Cardíaca , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Teste de Esforço/métodos , Alta do Paciente , Autoeficácia , JordâniaRESUMO
BACKGROUND AND OBJECTIVE: Clopidogrel is a potent antiplatelet drug that reduces the risk of vascular events in patients with cardiovascular disease. However, several studies have shown that about a quarter of patients showed low or no response to clopidogrel therapy. In this study, factors that contribute to clopidogrel resistance were investigated in 270 cardiovascular disease patients from Jordan. PATIENTS AND METHODS: Clopidogrel resistance was determined through platelet aggregation analysis using the Multiplate analyzer®. Genetic factors (CYP2C19*2 and PON1 Q192R) were examined using polymerase chain reaction-restriction fragment length polymorphism analysis. RESULTS: The incidence of clopidogrel resistance among Jordanians is about 32%. Significant association between clopidogrel resistance and female gender, concomitant use of calcium channel blockers, and low HDL was found (p < 0.05). In addition, presence of CYP2C19*2 allele is strongly related to clopidogrel resistance (p < 0.001). However, lack of contribution to clipidogrel resistance was found for PON1 Q192R polymorphism, age, diabetes, hypertension, smoking and aspirin use (p > 0.05). CONCLUSION: Several factors might contribute to clopidogrel resistance including gender, concomitant use of calcium channel blockers, HDL and CYP2C19*2 polymorphism.
Assuntos
Hidrocarboneto de Aril Hidroxilases/genética , Arildialquilfosfatase/genética , Doenças Cardiovasculares/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/análogos & derivados , Idoso , Doenças Cardiovasculares/genética , HDL-Colesterol/sangue , Clopidogrel , Citocromo P-450 CYP2C19 , Resistência a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Ticlopidina/uso terapêuticoRESUMO
The ECG changes produced by antipsychotics and other psychotropic medications are studied mostly regarding QTc interval prolongation. This study aimed to investigate ECG changes beyond long QTc interval produced by psychotropic medications. A cross-sectional study was conducted to assess the effect of these agents on RR, PR, TpTe intervals and TpTe/QT ratio among Jordanian outpatients. The RR interval was significantly shorter among patients on TCAs versus those not receiving TCAs and among patients on polytherapy versus those on monotherapy (p < 0.05 for both comparisons), when adjusted for age, gender, BMI, caffeine intake, smoking, presence of diabetes mellitus, cardiovascular disease and medications known to produce heart rate changes. Positive correlations were found between the PR interval and age in patients treated with SGAs, SSRIs, citalopram, polytherapy and in the total sample (p < 0.01 for all). Inverse correlations were found between the RR interval and the number of psychotropic medications among patients treated with SSRIs and in the whole study sample (p < 0.01 for both). In conclusion, various ECG changes beyond QTc interval prolongation are observed in patients on antipsychotics and other psychotropic medications, in those on polytherapy. It is recommended to obtain an ECG before starting patients on psychotropic drugs known to produce electrocardiographic changes and their combinations.
RESUMO
Acetyl salicylic acid (ASA) and clopidogrel are extensively used in the prevention of cardiovascular disease. However, the responsiveness to ASA treatment may vary among individuals. This study was conducted to investigate the profile and prevalence of ASA resistance in cardiac patients. From August 2007 to August 2008, a total of 282 cardiac patients were enrolled. Two study groups were identified: patients taking 100 mg ASA daily but without clopidogrel, and patients taking both 100 mg ASA and 75 mg clopidogrel daily. Platelet function was determined with the Multiplate analyzer to determine platelet responsiveness. Salicylate blood level was measured for all patients on ASA. Seventy-three patients (26%) were determined to be nonresponsive to ASA, and 45 patients (16%) were partially responsive, whereas 164 patients (58.2%) were responsive to ASA. Myocardial infarction and coronary obstruction were both strongly associated with ASA nonresponsiveness (p < 0.001). ASA resistance occurred more in female patients (p = 0.002). The salicylate blood level was found to be low in ASA-resistant patients (35.33 ± 50.22 mg/l) and higher in sensitive patients (54.26 ± 18.7 mg/l; p < 0.001). Quantitative assessment of platelet functions is predictive of ASA treatment failure in individual patients. Dual antiplatelet treatment with clopidogrel and ASA was found to have greater inhibitory effects on platelet aggregation than either agent alone. Non-adherence may be a significant mediator of poor outcome.
Assuntos
Aspirina/uso terapêutico , Doença da Artéria Coronariana/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Agregação Plaquetária/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Aspirina/sangue , Distribuição de Qui-Quadrado , Clopidogrel , Doença da Artéria Coronariana/sangue , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Modelos Logísticos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/sangue , Testes de Função Plaquetária , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Resultado do TratamentoRESUMO
Objective: To investigate the effect of psychotropic drugs and their combinations on the QTc interval as well as the prevalence of long QTc (LQTc) among ambulatory patients with psychiatric illness in Jordan. Methods: A cross-sectional study that included patients treated in an outpatient psychiatric clinic was conducted. The QTc duration was calculated using a combined QT correction (Bazett's formula for heart rate 60-100 and the Framingham formula for extremes of HR). Results: Among 307 patients, about 60% received multiple psychotropic drugs. The LQTc frequency was 1.2%. QTc interval prolongation was observed in patients receiving selective serotonin reuptake inhibitors (SSRIs) (P = .011), tricyclic antidepressants (TCAs) (P = .033), citalopram (P = .044), or psychotropic polytherapy (P = .005). The addition of SSRIs to second-generation antipsychotics (SGAs) also lengthened the QTc interval (P = .029). There was a correlation between the number of psychotropic medications and the QTc length (P = .018). All patients with LQTc carried at least one risk factor for it other than the use of psychotropic medication(s), 3 of 4 patients had a combination therapy, all patients were prescribed SSRIs, and 2 of them had comorbid conditions. Conclusion: There is a high prevalence of psychotropic drugs polytherapy, and it is clearly associated with LQTc. Citalopram, SSRIs, and TCAs prolong QTc interval. It is recommended to assess non-pharmacological factors for LQTc and, if necessary, to obtain an electrocardiogram before starting patients on psychotropic drugs known to prolong the QTc interval.
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OBJECTIVE: To assess the efficacy, tolerability and side effects of the diuretic hydrochlorothiazide (HCTZ) in the management of monosymptomatic nocturnal enuresis by a placebo-controlled double-blind crossover trial. PATIENTS AND METHODS: Forty patients suffering from nocturnal enuresis were blindly randomized into 2 groups of equal numbers. Group 1 first received placebo for 3 months, and group 2 received oral HCTZ once daily for the same period. Both groups, after a 2-week wash-out period, were crossed over in their medication and continued treatment for another 3 months. The main outcome measure (variable) for the assessment of drug efficacy was taken to represent the average reduction in the percentage of wet nights as compared to the baseline enuresis pattern. Statistical analysis was based on a t test (p Assuntos
Diuréticos/uso terapêutico
, Hidroclorotiazida/uso terapêutico
, Enurese Noturna/tratamento farmacológico
, Criança
, Estudos Cross-Over
, Método Duplo-Cego
, Feminino
, Humanos
, Masculino
, Estudos Prospectivos
RESUMO
Currently available biomedical adhesives are mainly engineered to have one function (i.e., providing mechanical support for the repaired tissue). To improve the performance of existing bioadhesives and broaden their applications in medicine, numerous multifunctional bioadhesives are reported in the literature. These adhesives can be categorized as passive or active by design. Passive multifunctional bioadhesives contain inherent compositions and structural designs that can carry out additional functions without added external influences. These adhesives exhibit new functionalities such as antimicrobial properties, self-healing abilities, the ability to promote cellular ingrowth, and the ability to be reshaped. Conversely, active multifunctional bioadhesives respond to environmental changes (e.g., pH, temperature, electricity, light, and biomolecule concentration), which initiate a change in the adhesive to release encapsulated drugs or to activate or deactivate the bioadhesive for interfacial binding. This review article highlights recent advances in multifunctional bioadhesives.
Assuntos
Anti-Infecciosos , Materiais Biocompatíveis , Adesivos Teciduais , Cicatrização/efeitos dos fármacos , Animais , Anti-Infecciosos/química , Anti-Infecciosos/uso terapêutico , Materiais Biocompatíveis/química , Materiais Biocompatíveis/uso terapêutico , Humanos , Adesivos Teciduais/química , Adesivos Teciduais/uso terapêuticoRESUMO
A simple two-step, shaking-assisted polydopamine (PDA) coating technique was used to impart polypropylene (PP) mesh with antimicrobial properties. In this modified method, a relatively large concentration of dopamine (20 mg ml-1) was first used to create a stable PDA primer layer, while the second step utilized a significantly lower concentration of dopamine (2 mg ml-1) to promote the formation and deposition of large aggregates of PDA nanoparticles. Gentle shaking (70 rpm) was employed to increase the deposition of PDA nanoparticle aggregates and the formation of a thicker PDA coating with nano-scaled surface roughness (RMS = 110 nm and Ra = 82 nm). Cyclic voltammetry experiment confirmed that the PDA coating remained redox active, despite extensive oxidative cross-linking. When the PDA-coated mesh was hydrated in phosphate saline buffer (pH 7.4), it was activated to generate 200 µM hydrogen peroxide (H2O2) for over 48 h. The sustained release of low doses of H2O2 was antibacterial against both gram-positive (Staphylococcus epidermidis) and gram-negative (Escherichia coli) bacteria. PDA coating achieved 100% reduction (LRV ~3.15) when incubated against E. coli and 98.9% reduction (LRV ~1.97) against S. epi in 24 h.
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High dietary sodium is recognized as a silent killer responsible for 2.3 million deaths worldwide in 2010 predominantly secondary to hypertension and its complications. Although high salt consumption is considered a worldwide public health problem, its magnitude is highly variable among different communities; therefore, it is important to study locally. This study aimed to evaluate habitual salt consumption, its important correlations, as well as the knowledge, attitude, and behavior of healthy Jordanian citizens. As potassium consumption is highly correlated and important we aimed to study both jointly. In this descriptive cross-sectional study we enrolled 103 healthy adult Jordanian citizens. All participants were interviewed for questionnaire filling, physical examination, and instructed on proper 24-hour urine collection procedure. We measured sodium and potassium concentration in the provided controlled 24-hour urine collection samples, as it is presently considered the gold standard for evaluating daily intake. The results showed an average sodium intake of 179 mmol (4.1 g) per day [higher in males at 186 mmol (4.3 g) vs. 173 mmol (4.0 g) for females], significantly above the current WHO recommendations, though only 8% regularly add salt to food. Ironically, most participants (82%) believe their salt consumption was appropriate and only 29% thought they may benefit from reducing salt intake. On the other hand, potassium intake is far below the current WHO recommendations. High sodium and low potassium intake have synergistic adverse effects on public health that is not currently addressed in Jordan. We conclude that Jordanian citizens currently consume high sodium and low potassium diet and are mostly unaware of its negative impact on their health. Hence, it is crucial for healthcare providers to intervene and adopt long-term strategies to control salt intake to reduce its negative effects in Jordan and elsewhere.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Cloreto de Sódio na Dieta/administração & dosagem , Adolescente , Adulto , Estudos Transversais , Comportamentos Relacionados com a Saúde , Voluntários Saudáveis , Humanos , Jordânia , Pessoa de Meia-Idade , Potássio na Dieta/administração & dosagem , Potássio na Dieta/urina , Fatores Sexuais , Cloreto de Sódio na Dieta/urina , Inquéritos e Questionários , Urinálise , Adulto JovemRESUMO
Coronary artery disease (CAD) and peripheral arterial disease (PAD) are serious manifestations of systemic atherosclerosis. A considerable proportion of patients with CAD have associated PAD; however, many are asymptomatic and this condition remains underdiagnosed. Little is known about the prevalence and clinical implication of PAD in patients undergoing coronary angiography in the Middle East with no history of the disease.To study the prevalence of previously unrecognized PAD of the lower limbs in patients undergoing coronary angiography, and to determine the correlation with CAD.This is a prospective study conducted at a university tertiary referral hospital. A total of 2120 patients referred for coronary angiography without a prior diagnosis of PAD, between January 1, 2014 and December 31, 2014, were included. Patients were evaluated through detailed medical history taking, a questionnaire survey to assess symptoms and functional status, ankle-brachial index (ABI) measurement, and coronary angiography. PAD was considered present if the ABI was <0.90 in either leg.In all patients, the prevalence of previously unrecognized PAD was 12.8%. There was no significant difference between men and women (13.4% vs 11.7%, Pâ=â.485). Abnormal angiographic results were seen in 82% (1739 of 2120). The prevalence of PAD was 14.7% in patients with abnormal coronary angiographic result, significantly higher than that in patients with normal results (4.5%, Pâ<â.0001). The prevalence of abnormal angiographic results among patients with and without PAD was 96% and 80%, respectively (Pâ=â.001). Factors independently related to PAD were age (odds ratio [OR] 1.081, 95% confidence interval [CI] 1.053-1.109; Pâ<â.001), hypertension (OR 3.122, 95% CI: 1.474-5.678; Pâ<â.004), diabetes (OR 1.827, 95% CI: 0.975-2.171; Pâ=â.04), smoking (OR 1.301, 95% CI: 0.725-2.076; Pâ<â.001), previous coronary artery bypass grafting (OR 2.939, 95% CI: 1.385-5.219; Pâ=â.004), previous cerebrovascular accident (OR 3.212, 95% CI: 1.872-9.658; Pâ=â.003), left main CAD (OR 9.535, 95% CI: 3.978-20.230; Pâ=â.002), and multivessel CAD (OR 1.869, 95% CI: 1.018-2.798; Pâ=â.03). Patients with CAD and PAD were associated with a higher prevalence of multivessel CAD (58.2% vs 42.6%, Pâ<â.005) and left main disease (3% vs 0.3%, Pâ<â.0001).The prevalence of undiagnosed PAD in patients undergoing coronary angiography was 12.8% (14.7% in patients with CAD) and associated with a higher incidence of cardiovascular risk factors, multivessel disease, and left main disease. The high prevalence of PAD in patients with CAD confirms the importance of active screening for PAD by using ABI. Routine determination of ABI in the clinical evaluation of all patients with CAD may help identify high-risk patients.
Assuntos
Doenças Assintomáticas/epidemiologia , Angiografia Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/complicações , Doença Arterial Periférica/epidemiologia , Idoso , Índice Tornozelo-Braço/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Achados Incidentais , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: Hypertension is a major cause of cardiovascular diseases with a high prevalence in Jordan. No previous studies have been carried out to determine the effect of the presence of drug-related problems (DRPs) on the health-related quality of life (HRQOL) among hypertensive patients. OBJECTIVES: The purpose of this study was to identify the influence of different types of DRPs on the HRQOL of hypertensive patients. METHODS: A total of 200 hypertensive patients were recruited in this cross-sectional correlation study that was conducted across the cardiac outpatient clinic at Jordan University Hospital. Ethical approval was obtained and patients were recruited using convenience sampling technique. During the study period, patients' data was used to evaluate their quality of life using RAND-12 scale and to identify DRPs utilizing a systematic evidence based approach. RESULTS: 200 hypertensive patients (mean age 59.7 years (SD=10.2)) were recruited in this study. Patients showed a poor quality of life on both the physical and mental domains of the RAND-12 scale. The average number of DRPs was 5.1 (SD=2.3). Multiple linear regression analysis showed that among DRPs categories, non-adherence to medications, non-adherence to non-pharmacological therapies and inadequate knowledge about medications were among the main predictors of the poor physical domain of the RAND-12 (Beta= -0.149, -0.226 and -0.230 respectively, p-value < 0.05 for all). On the other hand, only non-adherence to medication and non-adherence to non-pharmacological therapies were significantly associated with poor mental domain of the RAND-12 (Beta= -0.208 and -0.191 respectively, p-value < 0.05 for both). CONCLUSION: Prevalence of DRPs among hypertensive patients is a concern that needs attention. These DRPs were associated with poor HRQOL on both the physical and mental domain of the RAND-12 scale. The pharmaceutical care service delivered by pharmacists is needed to identify, prevent and resolve DRPs, which may improve patients HRQOL.
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Background and aims: Cardiovascular disease (CVD) is the leading cause of death in the Middle East. We sought to study the prevalence and coexistence of 6 cardiovascular risk factors (RFs) among patients who underwent percutaneous coronary intervention (PCI), and to evaluate the impact of age and gender on the presence of multiple RFs. METHODS AND RESULTS: In this prospective, multicenter study, 2426 consecutive patients were enrolled. Mean age was 59.0 ± 10.1 years and 500 (20.6%) were women. Acute coronary syndrome and stable coronary disease were the indications for PCI in 77.1% and 22.9%, respectively. Hypertension was present in 62.3%, diabetes in 53.8%, hypercholesterolemia in 48.8%, smoking in 43.5%, family history of premature CVD 39.4% and obesity in 28.8%. Only 3.8% did not have any of these RFs. Presence of ⩾3 and ⩾4 RFS was observed in 57.4% and 29.5% of patients, respectively. Presence of ⩾3 RFs was more common in women than men (69.0% vs. 54.5%, p < 0.0001), and among patients 41-65 years of age than older or younger patients (60.1% vs. 52.0% vs. 48.3%, respectively, p = 0.017). Conclusions: Cardiovascular RFs are highly prevalent in this PCI Middle Eastern population undergoing PCI. More than half and more than one-fourth of the patients had at least 3 or 4 RFs; respectively. More women than men and more middle aged patients than older or younger patients had significantly higher rates of presence of multiple RFs.
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AIM: This is a prospective multicenter registry designed to evaluate the incidence of adverse cardiovascular events in Middle Eastern patients undergoing percutaneous coronary interventions (PCI). The registry was also designed to determine the predictors of poor outcomes in such patients. METHODS AND RESULTS: We enrolled 2426 consecutive patients who underwent PCI at 12 tertiary care centers in Jordan between January 2013 and February 2014. A case report form was used to record data prospectively at hospital admission, discharge, and 12 months of follow-up. Mean age was 56 ± 11 years, females comprised 21% of the study patients, 62% had hypertension, 53% were diabetics, and 57% were cigarette smokers. Most patients (77%) underwent PCI for acute coronary syndrome. In-hospital and 1-year mortality rates were 0.78% and 1.94%, respectively. Definite or probable stent thrombosis occurred in 9 patients (0.37%) during hospitalization and in 47 (1.94%) at 1 year. Rates of target vessel repeat PCI and coronary artery bypass graft surgery at 1 year were 3.4% and 0.6%, respectively. The multivariate analysis revealed that cardiogenic shock, congestive heart failure, ST-segment deviation, diabetes, and major bleeding were significantly associated with higher risk of 1-year mortality. CONCLUSIONS: In this first large Jordanian registry of Middle Eastern patients undergoing PCI, patients treated were relatively young age population with low in-hospital and 1-year adverse cardiovascular events. Certain clinical features were associated with worse outcomes and may warrant aggressive therapeutic strategies.
RESUMO
BACKGROUND: The incidence, risk factors, and outcome of stent thrombosis (ST) after percutaneous coronary intervention (PCI) in Middle Eastern patients are largely unknown. OBJECTIVE: To determine the incidence, risk factors and outcome in our population. DESIGN: Retrospective study of a prospective multicenter registry of consecutive patients who underwent PCI between January 2013 and February 2014 (JoPCR1). SETTING: 12 tertiary care centers in Amman and Irbid, Jordan. PATIENTS AND METHODS: We collected clinical baseline and follow-up data. MAIN OUTCOME MEASURES: Incidence of stent thrombosis. RESULTS: The mean (standard deviation) age of patients (n=2426) was 59.0 (10.1) years and 20.6% were women. Stents (n=3038) were drug eluting (89.6%), bare metal (9.4%) or bioabsorbable (1.0%). After 1 year, 47 patients (1.97%) had ST, including 44 (94%) definite and 3 (6%) probable ST. Patients who had ST presented with sudden death (n=6; 12.2%) or with a nonfatal event (n=43; 87.8%). Nonfatal events included non-ST-segment elevation acute coronary syndrome (26; 53%), acute ST segment elevation myocardial infarction (n=15; 31%) or heart failure (n=2; 4.1%). ST was associated with significantly higher one-month (22.0% vs. 0.7%) and one-year (12.3% vs. 0.73%) mortality rates compared with patients who did not have ST (P < .001). ST patients were younger (mean age 52.9 years vs. 58.4 years), had heart failure (64% vs. 18%), left ventricular ejection fraction (LVEF) < 45% (36% vs. 13%), ST-segment deviation (70% vs. 48%), and elevated cardiac biomarkers blood levels (62% vs. 40%). In the multivariate analysis, the only factor that was significantly associated with ST was the heart failure (OR=3.5, 95% confidence interval: 1.8, 6.6; P < .0001). CONCLUSIONS: The incidence of ST was not different from that in other regions and was associated with an increased one-year mortality. Younger age, heart failure, low LVEF, ST-segment deviation, and elevated blood levels of cardiac biomarkers were predictors of ST. LIMITATIONS: Possible selection bias, recall bias, and missing or incomplete information. The majority of patients were lost to follow up after the 6th month. The registry may not fully represent PCI practice and outcome in all areas in the country or region.
Assuntos
Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias , Stents/efeitos adversos , Trombose/epidemiologia , Fatores Etários , Idoso , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Humanos , Incidência , Jordânia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Trombose/etiologia , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of this study is to determine the surgical indication in the treatment of infective endocarditis. SETTING: Retrospective study in a tertiary care--Wessex Cardiothoracic--Centre. SUBJECTS AND DESIGN: Case records of patients admitted with infective endocarditis for surgical treatment between 1984 to 1994 at Wessex Cardiothoracic Centre were analysed. This analysis includes the age, sex, microbiology results, risk factors, surgical indication and early results. RESULTS: A total of 123 patients was admitted with bacterial endocarditis treated surgically since 1984. The mean age was 51.9 years with male:female ratio of 3:1. The most common causative organism was streptococcus (63%) and staphylococcus (30%). Native valve endocarditis occurred in 111 patients, affecting the aortic, mitral, combined aortic and mitral valve in 69%, 33%, and 8% of cases, respectively. Late prosthetic valve endocarditis occurred in 12 patients. The most common indication for surgery was heart failure (84%), uncontrolled sepsis (8%), and recurrent endocarditis (2.5%). Hospital mortality was 1.6%. Complete heart block and cerebrovascular accident developed in 4% and 2.4%, respectively. CONCLUSIONS: Heart failure is the main indication for surgery. Valve replacement with mechanical prosthesis is a safe procedure with a low rate of mortality and complication.
Assuntos
Endocardite Bacteriana/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , UltrassonografiaRESUMO
Protein C deficiency is an inherited thrombophilia presented in adults with venous thrombosis at different sites. Symptomatic biatrial thrombus presentation of protein C deficiency has not, to my knowledge, been described. This report investigates a man with protein C deficiency who presented with dyspnea and recurrent attacks of dizziness associated with biatrial thrombus. Complete disappearance of the symptoms and thrombi was observed within less than 3 weeks of anticoagulation.