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Alfadda AA, Youssef AM, Al-Sofiani ME, Amin HS, AlOtaibi O, Mohamed N, Algohani HA, Isnani A, Rafiullah M. Medication Adherence and Treatment Satisfaction With Lipid-Lowering Drugs Among Patients With Diabetes and Dyslipidemia. Ann Pharmacother 2024:10600280241262513. [PMID: 39054790 DOI: 10.1177/10600280241262513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Poor adherence to lipid-lowering drugs in diabetic patients with dyslipidemia increases has been linked with an increased cardiovascular risk. A better understanding of the determinants of adherence to lipid-lowering drugs and treatment satisfaction among people with diabetes and dyslipidemia is crucial. OBJECTIVE We aimed to assess the prevalence of adherence to lipid-lowering drugs, identify its determinant factors, and evaluate treatment satisfaction among users of lipid-lowering drugs who have diabetes and dyslipidemia. METHODS We surveyed 398 adult patients with diabetes and dyslipidemia, using a validated medication adherence survey (Adherence to Refills and Medications Scale) and a validated treatment satisfaction survey (Treatment Satisfaction Questionnaire for Medication, TSQM). Sociodemographic and medical history data were collected through questionnaires. RESULTS The prevalence of poor medication adherence was 36%. Factors associated with poor adherence included adverse reactions to medications, lack of medication availability, and lack of family support. Adherent patients reported lower low-density lipoprotein-cholesterol (LDL-C) and total cholesterol levels, higher treatment satisfaction, and a higher prevalence of cardiovascular disease and comorbidities. Having a family history of dyslipidemia was negatively associated with adherence, while the number of comorbidities positively influenced it. The scores of TSQM components such as effectiveness, global satisfaction, and convenience were significantly higher in people who were adherent or achieved the LDL-C target. CONCLUSION AND RELEVANCE Our findings highlight the need for interventions targeting several factors impacting adherence to lipid-lowering drugs in patients with diabetes and dyslipidemia. Managing adverse effects, leveraging family support, and ensuring medication access represent crucial aspects of improving adherence and potentially mitigating cardiovascular risks in this high-risk population.
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Affiliation(s)
- Assim A Alfadda
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amira M Youssef
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed E Al-Sofiani
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hussein Saad Amin
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Obeed AlOtaibi
- University Diabetes Center, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Nourhan Mohamed
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hossam Ayed Algohani
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Arthur Isnani
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Rafiullah
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Al-Shudifat AE, Hammoudeh AJ, Al Saud W, Ibdah R, Araydah M, Zaqqa A, Fakhri ZR, Haikal LHF, Abuhalimeh LJ, Alghabban Z, Ja'arah D, Al-Mashayikh AN, Alhaddad I. Coexistence of Standard Modifiable, Other Classical, and Novel and Classical Atherosclerotic Cardiovascular Disease Risk Factors in Middle Eastern Young Women. Vasc Health Risk Manag 2024; 20:313-322. [PMID: 39005236 PMCID: PMC11244616 DOI: 10.2147/vhrm.s468209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
Background The coexistence of multiple standard modifiable risk factors (SMuRFs),classical and novel risk factors (RFs) for atherosclerotic cardiovascular disease (ASCVD) is common in the Middle East (ME). There is a paucity of data on the coexistence of these RFs in ME young women. Aim Comparing the prevalence and the statistical patterns of the SMuRFs, classical and novel RFs in target population. Methods In this case-control (1:2) study, consecutive young women aged 18-50 years were enrolled in 12 centers (July 2021 to October 2023). Prevalence and coexistence of 19 RFs were compared between cases with ASCVD and their controls. The RFs included SMuRFs (hypertension, type 2 diabetes, dyslipidemia, and cigarette smoking), other classical RF (obesity, family history of premature ASCVD, and physical inactivity), novel RFs and social determinants of health (health insurance, place of residence, depression, and level of education). Results The study included 627 subjects; 209 had ASCVD (median age 46 years, IQR 49-42 years) and 418 controls (median age 45 years, IQR 48-41 years). The presence of 1-2 RFs; (ASCVD: 63.2%, Control: 54.1%, p=0.037) and 3-4 RFs; (ASCVD: 27.8%, Control: 3.3%, p < 0.001) SMuRFs was more prevalent in women with ASCVD. Similarly, the presence of 4-5 RFs; (ASCVD: 40.7%, Control: 14.6%, p<0.001), and 6-7 (ASCVD: 10.5%, Control: 1%, p < 0.001). The classical RF were also significantly common in these women. The distribution of multiple novel RF was not statistically significant across both groups. Finally, regarding the socioeconomic RFs in women with ASCVDs, the presence of 1-2 RFs (ASCVD: 59.8%, Control: 76.1%, p < 0.001) was significantly less common while the presence of 3-4 RFs (ASCVD: 39.2%, Control: 21.8%, p < 0.001) was vastly more common. Conclusion An elevated rate of coexistence of classical RF in the case group, mainly socioeconomic and SMuRFs. By managing them primary and secondary ASCVDs prevention attained.
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Affiliation(s)
- Abdel-Ellah Al-Shudifat
- Department of Internal and Family Medicine, Faculty of Medicine The Hashemite University, Zarqa, Jordan
| | | | - Wesam Al Saud
- Department of Clinical Pharmacy, Princess Salma Hospital, Ministry of Health, Amman, Jordan
| | - Rashid Ibdah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Araydah
- Department of Internal Medicine, Istishari Hospital, Amman, Jordan
| | - Ayah Zaqqa
- Department of Clinical Research, Istishari Hospital, Amman, Jordan
| | - Zainab Raed Fakhri
- Medical Education department, King Abdullah University Hospital, Irbid, Jordan
| | | | | | - Zahraa Alghabban
- Medical Education department, Jordan University Hospital, Amman, Jordan
| | - Daria Ja'arah
- Medical education, Istishari Hospital, Amman, Jordan
| | | | - Imad Alhaddad
- Director of Cardiovascular Department, Jordan Hospital, Amman, Jordan
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Dung NJ, Tettey MM, Tamatey M, Sereboe LA, Doku A, Adu-Adadey M, Agyekum F. Angiographic severity of coronary artery disease and the influence of major cardiovascular risk factors. Ghana Med J 2023; 57:262-269. [PMID: 38957846 PMCID: PMC11215219 DOI: 10.4314/gmj.v57i4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Objective To determine the angiographic severity of coronary artery disease (CAD) and assess the influence of major cardiovascular risk factors (CVRF). Study design a cross-sectional, hospital-based study. Setting the catheterisation laboratory of the National Cardiothoracic Centre, Accra, Ghana. Participants for 12 months, consecutive patients admitted for coronary angiography were assessed for the presence of CVRFs. Those with significant CAD after angiography were recruited into the study. Intervention The patient's angiograms were analysed, and the CAD severity was obtained using the SYNTAX scoring criteria. Main outcome measure The lesion overall severity (SYNTAX) score and the relationship with CVRFs present. Results out of the 169 patients that had coronary angiography, 78 had significant CAD. The mean SYNTAX score was 20.18 (SD= 10.68), with a significantly higher value in dyslipidaemic patients (p < 0.001). Pearson's correlation between the score and BMI was weak (r= 0.256, p= 0.034). The occurrence of high SYNTAX score lesions in about 18% of the population was significantly associated with hypertension (OR= 1.304, 95% CI [1.13-1.50]; p= 0.017) dyslipidaemia (OR= 5.636, 95% CI [1.17-27.23]; p= 0.019), and obesity (OR= 3.960, 95% CI [1.18-13.34]; p= 0.021). However, after adjusting for confounding factors, only dyslipidaemia significantly influenced its occurrence (aOR= 5.256, 95% CI [1.03-26.96]; p= 0.047). Conclusion Even though the most severe form of CAD was found in about one-fifth of the study population, its occurrence was strongly influenced by the presence of dyslipidaemia. Funding None.
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Affiliation(s)
- Nehemiah J Dung
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
- Cardiothoracic Surgery Division, Surgery Department, Jos University Teaching Hospital, Jos, Nigeria
| | - Mark M Tettey
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Martin Tamatey
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Lawrence A Sereboe
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Alfred Doku
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Martin Adu-Adadey
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Francis Agyekum
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
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Ali Zarie A, Osman MA, Alshammari GM, Hassan AB, ElGasim Ahmed Yagoub A, Abdo Yahya M. Saudi date cultivars' seed extracts inhibit developing hepatic steatosis in rats fed a high-fat diet. Saudi J Biol Sci 2023; 30:103732. [PMID: 37588573 PMCID: PMC10425400 DOI: 10.1016/j.sjbs.2023.103732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 08/18/2023] Open
Abstract
This research aim was to assess the impact of the seed extracts of the date cultivars (Qatara, Barhi, and Ruthana) on rat's liver steatosis, oxidative stress, and inflammation triggered by feeding a high-fat diet (HFD). The experimental design was based on random partitioning into two groups; one that received the standard diet and another that received the HFD diet. The HFD rats were orally administered Lipitor or date seed extracts at 300 or 600 mg/kg/day for 4 weeks. Accordingly, feeding rats HFD significantly increased body and liver weights, hepatic and serum lipid levels, glucose, insulin, HOMA-IR, liver function enzymes, and inflammation markers, and decreased oxidative stress enzymes. Oral administration of Barhi and Ruthana date seed extracts significantly decreased body and liver weights. Serum and liver total cholesterol TC, Triglycerides TGs, and free fatty acids FFAs were also decreased as were AST, ALT, MAD, leptin, and CRP, with a concomitant increase in SOD, GSH, and CAT. Furthermore, similar to Lipitor, oral administration of the extracts reduced inflammation markers such as TNF-α, serum CRP, IL-6, IL-1β, and leptin while increasing IL-10 and adiponectin levels. Histological observation revealed that extract administration improved hepatocyte and parenchymal structures and decreased lipid deposition. In conclusion, both Barhi and Ruthana seed extracts showed strong hepatoprotective, anti-inflammatory, and antioxidant effects against HFD-induced liver steatosis. And date seeds have other beneficial potential for prevention and treatment of various diseases, which can be studied in the future.
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Affiliation(s)
- Arwa Ali Zarie
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Magdi A. Osman
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ghedeir M. Alshammari
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Amro B. Hassan
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abu ElGasim Ahmed Yagoub
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammed Abdo Yahya
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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Alshammri MR, Alhudayris FS, Alshuaibi LK, Alhusaini BA, Alfozan OA, Alsaleh AA, Alzmamy SA. Heart Failure Awareness Among the General Saudi Population: A Cross-Sectional Study. Cureus 2023; 15:e42077. [PMID: 37602039 PMCID: PMC10434818 DOI: 10.7759/cureus.42077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Background Heart failure (HF) continues to be a globally prevalent condition with a poor prognosis, severe morbidity, and a high mortality rate. Despite the severity of HF, relatively few studies on public awareness of the condition have been published, with the majority indicating that awareness is quite low. This study aimed to determine HF knowledge in the general Saudi community and its associated predictors. Methods An online survey was used to conduct a cross-sectional study on the Saudi population. The publicity committee of the Korean Society of Heart Failure drafted the questionnaire used in the present investigation. Three questions assessed knowledge of cardiovascular (CV) and cerebrovascular disorders; four questions assessed knowledge of HF, its etiology, and severity; and three questions assessed knowledge of readmission, mortality, and lifetime risk. Results A total of 1,124 respondents completed the questionnaire. Approximately half of the respondents (50.1%, n = 563) were unaware that HF is a pathological rather than a physiological process. Only 13.8% of the respondents were aware that the lifetime risk of developing HF is 20%, with even lower rates of correct responses for the one-year readmission rate (7.4%) and post-discharge one-year mortality from acute HF (7.3%). Female gender and lower levels of education were associated with a lack of HF awareness. A multivariate analysis revealed that income and information source were substantially associated with cardiovascular disorder knowledge. Age, education, alcohol consumption, and information source were associated with awareness of the severity of HF. Conclusion The general population in Saudi Arabia (SA) exhibited a relatively low degree of knowledge of HF. We suggest increasing public awareness of HF through an educational campaign led by medical personnel and disseminated via various social media websites. Changes should be made to national healthcare policies to provide healthcare institutions with continuous promotion and iterative campaigns about healthy lifestyles and preventive activities to reduce disease-related costs and disability. HF awareness must be raised through increased concentration and education.
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Affiliation(s)
- Mohammad R Alshammri
- Department of Cardiology, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | | | | | | | | | - Saad A Alzmamy
- Department of Orthopedic Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Aljehani R, Grace SL, Aburub A, Turk-Adawi K, Ghisi GLDM. Translation, Cross-Cultural Adaptation and Psychometric Validation of the Arabic Version of the Cardiac Rehabilitation Barriers Scale (CRBS-A) with Strategies to Mitigate Barriers. Healthcare (Basel) 2023; 11:healthcare11081196. [PMID: 37108029 PMCID: PMC10138187 DOI: 10.3390/healthcare11081196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiac rehabilitation (CR) utilization is low, particularly in Arabic-speaking countries. This study aimed to translate and psychometrically validate the CR Barriers Scale in Arabic (CRBS-A), as well as strategies to mitigate them. The CRBS was translated by two bilingual health professionals independently, followed by back-translation. Next, 19 healthcare providers, followed by 19 patients rated the face and content validity (CV) of the pre-final versions, providing input to improve cross-cultural applicability. Then, 207 patients from Saudi Arabia and Jordan completed the CRBS-A, and factor structure, internal consistency, construct, and criterion validity were assessed. Helpfulness of mitigation strategies was also assessed. For experts, item and scale CV indices were 0.8-1.0 and 0.9, respectively. For patients, item clarity and mitigation helpfulness scores were 4.5 ± 0.1 and 4.3 ± 0.1/5, respectively. Minor edits were made. For the test of structural validity, four factors were extracted: time conflicts/lack of perceived need and excuses; preference to self-manage; logistical problems; and health system issues and comorbidities. Total CRBS-A α was 0.90. Construct validity was supported by a trend for an association of total CRBS with financial insecurity regarding healthcare. Total CRBS-A scores were significantly lower in patients who were referred to CR (2.8 ± 0.6) vs. those who were not (3.6 ± 0.8), confirming criterion validity (p = 0.04). Mitigation strategies were considered very helpful (mean = 4.2 ± 0.8/5). The CRBS-A is reliable and valid. It can support identification of top barriers to CR participation at multiple levels, and then strategies for mitigating them can be implemented.
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Affiliation(s)
- Raghdah Aljehani
- Rehabilitation Department, King Abdullah Medical City, Makkah 24246, Saudi Arabia
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Aseel Aburub
- Department of Physiotherapy, Applied Science Private University, Amman 11931, Jordan
| | - Karam Turk-Adawi
- College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
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Wilson AA, Emiliene K, Ndasi NP, Jong NE. Optimization of the pulp ratio of Ananas comosus, Citrullus lanatus and Psidium guajava and fermentation time in the production of a “fruit brandy”. Heliyon 2023; 9:e14910. [PMID: 37064441 PMCID: PMC10102199 DOI: 10.1016/j.heliyon.2023.e14910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Brandy, produced by the distillation of wine, is highly consumed in Cameroon, most of which is imported, whereas this region harnesses a vast diversity of fruits, which could be exploited in producing wines and spirits. These fruits have interesting health virtues and are prone to rapid postharvest losses. This study is aimed at producing brandy from a combination of pineapple (Ananas comosus), watermelon (Citrullus lanatus) and guava (Psidium guajava), with an objective to optimize the ratio of fruit pulps and fermentation time in order to produce wine, then brandy of acceptable taste and flavor. A D-optimal 3-component, 1-factor experimental design was used to obtain the best wine formulation to be distilled. The factors retained were: the volumes of Pineapple (A), watermelon (B) and guava (C) and the fermentation time (D) was considered as a process factor. Based on the experimental design using Design Expert 11 software, 24 wine samples were formulated. After statistical analyses, the pH, alcohol content and viscosity were considered for mathematical modeling due to their significant impacts during fermentation (pH and viscosity) and distillation (alcohol content). Optimization for wine production gave a fruit formulation of 69, 19 and 12% of pineapple, watermelon and guava respectively, with a fermentation time of 11 days. Distillation of this wine gave an ethanol output of 72%, from which two distinct Brandy was obtained: one (E1) in which dilution was done with clarified wine, and the second (E2) with distilled water and a roasted bark of Cupressus sempervirens (cypress) added to it. After six weeks of aging at ambient temperature, physicochemical characteristics showed a vitamin C content of 100 and 80 mg/L, polyphenols content of 22.77 and 42.77 mqGAE/100 g, and a titratable acidity of 1.42 and 0.45 meq.g of tartaric acid respectively for E1 and E2. After sensory analysis, brandy sample E1 was preferred.
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Changes in the Anxiety Levels of Patients Undergoing Percutaneous Coronary Intervention. Dimens Crit Care Nurs 2023; 42:15-21. [DOI: 10.1097/dcc.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Al Sayed N, Almahmeed W, Alnouri F, Al Waili K, Sabbour H, Sulaiman K, Zubaid M, Ray KK, Al-Rasadi K. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East – 2021 update. Atherosclerosis 2021; 343:28-50. [DOI: 10.1016/j.atherosclerosis.2021.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
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Lami F, Elfadul M, Rashak HA, Al Nsour M, Akhtar H, Khader YS, Hussein AM, Naciri M, Samy S, Ghaleb Y, Taha HA, Aljanabe AH, Ali NA, Zayer RH, Ikram A, Rahman FU, Khan MM, Adam R, Ahmed AY, Afifi S. Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: A Multicountry Retrospective Study . JMIR Public Health Surveill 2021; 8:e32831. [PMID: 34736222 PMCID: PMC8929409 DOI: 10.2196/32831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The establishment of empirical evidence in the Eastern Mediterranean Region (EMR) necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of COVID-19 patients. OBJECTIVE This study aimed to assess the patterns of COVID-19 severity and mortality in seven countries and to determine the risk factors of COVID-19 severity and mortality. METHODS This multi-country study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study included data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors. RESULTS A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (HT) (24.7%) and diabetes (22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity. CONCLUSIONS The study confirmed the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.
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Affiliation(s)
- Faris Lami
- University of Baghdad, Department of Community and Family Medicine, Baghdad, IQ
| | - Maisa Elfadul
- University of Medical Sciences amd Technology ,Sudan, Federal Minstry of Health, Airport avenue,, Khartoum, SD
| | | | - Mohannad Al Nsour
- Global Health Development (GHD), The Eastern Mediterranean Public Health Network (EMPHNET), Amman, JO
| | - Hashaam Akhtar
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental Collage, Islamabad, PK
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine/ Faculty of Medicine, Jordan University of Science & Technology, Amman, JO
| | | | - Mariam Naciri
- Research Center Biotechnology, Biodiversity and Environment (BIOBIO), Laboratory of Biodiversity, Ecology and Genome, Biology Department, Faculty of Sciences, Mohammed V University, Rabat, MA
| | - Sahar Samy
- Communicable disease control department - Preventive Sector, Ministry of Health and Population, Cairo, EG
| | - Yasser Ghaleb
- Ministry of Public Health and Population, Yemen Field Epidemiology Training Program, Sana'a, YE
| | - Hana Ahmad Taha
- Global Health Development (GHD)
- Eastern Mediterranean Public Health Network, Health Protection and Promotion, Amman, JO
| | | | | | - Raheem Hussein Zayer
- Al-Rusafa Health Directorate, Public Health Department, Ministry of Health, Baghdad, IQ
| | | | - Fazal Ur Rahman
- Medical Unit 1 Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, PK
| | | | - Reema Adam
- Federal Ministry of Health, Directorate of Emergency and Humantarian actions, Khartoum, SD
| | | | - Salma Afifi
- Ministry of Health and Population, Cairo, EG
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Lami F, Elfadul M, Rashak H, Al Nsour M, Akhtar H, Khader Y, Hussein AM, Naciri M, Samy S, Ghaleb Y, Taha H, Hussein A, Ali NA, Hussein R, Ikram A, Rahman FU, Khan MM, Adam R, Ahmed AY, Afifi S. Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study (Preprint).. [DOI: 10.2196/preprints.32831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND
The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19.
OBJECTIVE
This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality.
METHODS
This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors.
RESULTS
A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity.
CONCLUSIONS
The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.
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Tsioufis K, Kreutz R, Sykara G, van Vugt J, Hassan T. Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes: a rapid evidence assessment of recent literature. J Hypertens 2021; 38:1016-1028. [PMID: 32371789 PMCID: PMC7253190 DOI: 10.1097/hjh.0000000000002381] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The 2018 European Society of Cardiology/European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension. This systematic rapid evidence assessment sought to determine if initiating SPC therapy improves adherence, blood pressure (BP) control and/or cardiovascular outcomes vs. initiation of free-dose combination therapy.
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Affiliation(s)
- Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Reinhold Kreutz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Georgia Sykara
- Medical Affairs, Pfizer Upjohn Hellas Ltd, Athens, Greece
| | - Joris van Vugt
- Medical Affairs, Pfizer Upjohn, Cappelle a/d Ijssel, The Netherlands
| | - Tarek Hassan
- Medical Affairs, Pfizer Upjohn, New York, New York, USA
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Sadeghi M, Rahiminam H, Amerizadeh A, Masoumi G, Heidari R, Shahabi J, Mansouri M, Roohafza H. Prevalence of Return to Work in Cardiovascular Patients After Cardiac Rehabilitation: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2021; 47:100876. [PMID: 34034921 DOI: 10.1016/j.cpcardiol.2021.100876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 01/11/2023]
Abstract
The present systematic review and meta-analysis aimed to clarify the effects of cardiac rehabilitation (CR) on the prevalence of return to work (RTW) in cardiovascular diseases (CVDs) patients. CR plays a very important role in the management of CVDs and improves the patients' physical activity, quality of life, and a decrease in the cost of healthcare. RTW is the most important goal in the rehabilitation of CVD patients. PubMed, Web of Science, Scopus, and Google scholar were searched systematically from inception up to January 2021 for English published clinical trials and observational studies. In total, 16 studies were analyzed, of them, 8 were controlled studies. Pooled results showed that the mean age of patients was 52.30 (50.04, 54.57). The prevalence of RTW in the CR attending group was 66% (60%, 71%) and in the control group was 58% (47%, 68%). Subgroup analysis showed that the proportion of RTW was higher in white-collars 76% (73%-79%) compared to. blue-collars 63% (56%-70%). Out-patient CR with 72% (61%-81%) RTW was more effective compared to in-patient CR with 62% (44%- 78%) and usual care (control). It can be concluded that CR especially out-patient CR increases the prevalence of RTW but not much. Improved and appropriate CR programs related to each individual's disease and patient condition which follow the valid guidelines might help to increase the effectiveness of CR in terms of RTW.
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Affiliation(s)
- Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Hadis Rahiminam
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefeh Amerizadeh
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Masoumi
- Anesthesiology Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Heidari
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Shahabi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadhadi Mansouri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Differences in the Cardiovascular Risk Assessment in Cardiology Outpatients in Mali: Comparison between Framingham Body Mass Index-Based Tool and Low-Information World Health Organization Chart. Int J Hypertens 2021. [DOI: 10.1155/2021/8862762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective. This study aimed to compare 2 laborless tools, namely, the body mass index-based Framingham (bmi-Frm) and low-information WHO- (li-WHO-) based risk scores, and assess their agreement in outpatients in a cardiology department. Methodology. Data stem from a cross-sectional previous study performed from May to September 2016 in the Cardiology Department of University Hospital Gabriel Touré (UH-GT) in Bamako. All patients aged 40 and more were included in the study allowing the assessment of bmi-Frm and li-WHO prediction charts. The cardiovascular risk (CVR) was evaluated using a calculator prepared by D‘Agostino et al. for the bmi-Frm and the li-WHO chart for the Afro-D region of the WHO. The risk score for both ranged from <10 to ≥40. The data were entered in an ACCESS 2010 database, then processed by MS Excel 2010, and finally analysed using IBM SPSS Statistics 20. Continuous variables were presented as means and standard deviations, and categorical variables were presented as frequencies with percentages.
was considered the statistical significance level. After sample description, the risk score was assessed using bmi-Frm and li-WHO prediction tools. Finally, a kappa test was performed to check for the interreliability of both methods. For weighted kappa, coefficients were given all five classes of risk groups in 0, 25 steps from 1 for total concordance to 0 for total discordance. Results. This study involved 793 outpatients, 63.7% being female, 35.1% of them younger than 50 years, 57.9% with no formal education, and 67.7% with no medical insurance. Means for age, body mass index (BMI), and systolic blood pressure (SBP) were, respectively, 53.81 ± 16.729 years, 25.29 ± 06.151 kg/m2, and 139.49 ± 27.110 mm Hg. Using the li-WHO prediction chart gives a much higher proportion of low-risk patients compared to bmi-Frm (83.6 vs. 37.7). Sociodemographic characteristics such as education or income level were not different in risk score neither for the bmi-Frm nor for the li-WHO risk score. The percentage of agreement between both tools was 40.4%, and agreement (kappa of 0.1 and weighted kappa of 0.2) was found to be slight. Conclusion. Using the bmi-Frm and li-WHO tool gives a similar risk estimation in younger female patients. Older patients must be evaluated using high-information tools with cholesterol, e.g., versions of the Framingham risk equation or WHO using cholesterol. These must be confirmed in further studies and compared to data from prospective studies
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Al-Zahrani J, Shubair MM, Al-Ghamdi S, Alrasheed AA, Alduraywish AA, Alreshidi FS, Alshahrani SM, Alsalamah M, Al-Khateeb BF, Ashathri AI, El-Metwally A, Aldossari KK. The prevalence of hypercholesterolemia and associated risk factors in Al-Kharj population, Saudi Arabia: a cross-sectional survey. BMC Cardiovasc Disord 2021; 21:22. [PMID: 33413091 PMCID: PMC7792200 DOI: 10.1186/s12872-020-01825-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/14/2020] [Indexed: 01/14/2023] Open
Abstract
Background Hypercholesterolemia (HC) is an important precursor to many cardiovascular, cerebrovascular, and peripheral vascular diseases. A report conducted by the American Heart Association showed the prevalence of HC to be 11.9%, with around 28.5 million adults age ≥ 20 years having high cholesterol levels. This study aimed to evaluate the prevalence of HC and its associated risk factors among the general population of Al-Kharj, Saudi Arabia.
Method A cross-sectional study was conducted on the general population of Al-Kharj, Saudi Arabia in 2016. The representative sample consisted of 1019 individuals, who all participated on a voluntary basis. The statistical analysis was performed using SPSS version 25. Results The results of this study showed the prevalence of HC in the sample to be 12.5%. There was a significant moderate positive association between increasing age and the prevalence of HC (r = 0.240, P < 0.0001). Males had a significantly higher prevalence of HC (56.7%) compared to their female counterparts (43.3%) (X2 = 23.093, P ≤ 0.0001). BMI was positively and significantly associated with high cholesterol status. Participants in the overweight category had a significantly higher risk of HC (OR = 1.727; 95% CI = 1.58–1.914; P = 0.046). The non-obese (< 25 kg/m2) participants had an inverse significant association with the risk of hypercholesterolemia. (OR = 0.411; 95% CI = 0.216–0.783; P = 0.007).
Conclusion In this population-based study, the predominant risk factors of HC in Al-Kharj region were being of a Saudi nationality, male, having obesity, being unemployed, and being a civilian worker. There is a clear need for future screening studies of HC, as most previous studies have reported contradictory prevalence data (because they were conducted in different regions of KSA). Furthermore, well-designed prospective cohort studies are needed in the future to assess how the association between lifestyle behavioural factors such as dietary intake patterns and levels of physical activity may affect the relative risk of HC status.
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Affiliation(s)
- Jamaan Al-Zahrani
- Family and Community Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia.
| | - Mamdouh M Shubair
- School of Health Sciences, University of Northern British Columbia (UNBC), 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Sameer Al-Ghamdi
- Family and Community Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Abdullah A Alrasheed
- Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Fayez Saud Alreshidi
- Family and Community Medicine Department, College of Medicine, University of Hail, Hail, Saudi Arabia
| | | | - Majid Alsalamah
- Department of Emergency Medicine, King Abdulaziz Medical City, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Badr F Al-Khateeb
- Department of Family Medicine, King Abdulaziz Medical City, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Aljawharah Ibraheem Ashathri
- Clinical Nutrition, Community Health Department, Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Ashraf El-Metwally
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khaled K Aldossari
- Family and Community Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
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Alsaud W, Tabbaa MJ, Kasabri VN, Suyagh MF, Abu Alsamen MA, Haddad HM, ALshweki AO. Prevalence of Cardiovascular Diseases Risk Factors among Jordanians. J Saudi Heart Assoc 2020; 32:324-333. [PMID: 33154938 PMCID: PMC7640553 DOI: 10.37616/2212-5043.1074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background and aims One of the most common causes of death worldwide is cardiovascular diseases (CVDs). This study evaluated the prevalence of CVDs risk factors (RFs) and their constellation electively among the Jordanian population and, assessing the most prevalent RF interplay with the rest of CVDs RFs as well as the impact of age and gender dimorphism on the frequencies of coexistence of multiple CVDs risk factors (RFs) among the Jordanian population. Methods and results In this observational multicenter study, a total of 1449 subjects were enrolled. The mean age (±SD) was 44.35 ± 14.46 years; 796 (54.9%) of them were females and 801 (55.28%) of the whole study pool had no family history of premature CVDs. Only 5.9% of the population did not have any of these RFs. The prevalence of CVDs MRFs within-affected subjects was as follows: there were 1081 (74.6%) subjects with overall dyslipidemia, 471 (32.51%) with obesity, 456 (31.47%) were smokers, and at the first diagnostic encounter 541 (37.47%) were with elevated blood pressure and, 310 (21.51%) were with elevated random blood sugar. The coexistence of ≥ two, ≥ three and, ≥ four RFs was observed in 75.7%, 44.4%, and 21.4% of the subjects, respectively. The constellation of multiple RFs was more frequent in men than that in women, where the presence of ≥ two RFs for men was at 86.18% vs. 67.09% for women. Similarly, the appearance of multiple RFs increases with age, starting from the existence of ≥ three, and four RFs respectively. Most notably the clustering of ≥ five RFs in the age group of 45–59 years showed the greatest frequency vs. any other age group. Conclusions CVDs risk factors (RFs) and clusters of them are extremely prevalent in the Jordanian population. Overall dyslipidemia is the most prevalent MRF and the most favors clustering with other CVDs RFs. Combined two RFs had the highest proportional frequency between all six RFs clusters. The constellation of at least two, three, and four CVDs RFs presented at almost three-fourth, half, and around one-fourth; respectively, Middle-aged males presented significantly higher rates of ≥ five RFs occurrences than females.
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Affiliation(s)
- Wesam Alsaud
- Scientific Office, Jordanian Pharmaceutical Company, Amman, Jordan
| | | | | | | | | | | | - Anas O ALshweki
- Scientific Office, Jordanian Pharmaceutical Company, Amman, Jordan
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17
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Sawaya T, Ballouz T, Zaraket H, Rizk N. Coronavirus Disease (COVID-19) in the Middle East: A Call for a Unified Response. Front Public Health 2020; 8:209. [PMID: 32574298 PMCID: PMC7248320 DOI: 10.3389/fpubh.2020.00209] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tania Sawaya
- Division of Biology and Medicine, Undergraduate Program in Biology, Department of Molecular Microbiology and Immunology, Brown University, Providence, RI, United States
| | - Tala Ballouz
- Department of Public Health, Epidemiology Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology, and Microbiology, Center of Infectious Disease, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nesrine Rizk
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Okai DE, Manu A, Amoah EM, Laar A, Akamah J, Torpey K. Patient-level factors influencing hypertension control in adults in Accra, Ghana. BMC Cardiovasc Disord 2020; 20:123. [PMID: 32156259 PMCID: PMC7065309 DOI: 10.1186/s12872-020-01370-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023] Open
Abstract
Background Effective control of blood pressure is necessary to avert the risk of cardiovascular diseases from uncontrolled hypertension. Despite evidence on the benefits of hypertension control, rates of control in Ghana remain low. This study assessed the patient-level factors that influence hypertension control among adults in Accra, Ghana. Methods A total of 360 hypertensive patients from two hospitals in Accra, Ghana were enrolled in the study. Patient socio-demographic characteristics were tabulated and associations between patient characteristics and hypertension control were estimated using chi-square tests and logistic regression. Results Less than a quarter of the patients had a controlled blood pressure. The patient’s sex [AOR = 3.53 (95% CI:1.73–7.25], educational at junior high school [AOR = 3.52(95% CI 1.72–7.22)], senior and junior high school [AOR = 2.64 (95% CI 1.40–6.66_] and AOR = 3.06 (95% CI 1.03–6.67)] and presence of a comorbidity [AOR = 2.41 (95% CI 1.32; 4.42)] predicted BP control among patients. Dyslipidaemia [AOR = 0.31, [0.11–0.89)] an increased pill burden, and length of diagnosis of 2–5 years (AOR = 0.27 (0.1–0.73)] however, were associated with reduced BP control [AOR = 0.32(95% CI: 0.18–0.57)]. The majority of patients reported forgetfulness, side effects of medication and high pill burden as reasons for missing their medications. Conclusion Knowledge of hypertension among patients is low. Sex, formal education and the presence of comorbidity and more specifically dyslipidaemia influences blood pressure control. High pill burden and 2–5 years since diagnosis negatively affects the attainment of blood pressure control.
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Affiliation(s)
| | - Adom Manu
- University of Ghana School of Public Health, Accra, Ghana
| | | | - Amos Laar
- University of Ghana School of Public Health, Accra, Ghana
| | - Joseph Akamah
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Kwasi Torpey
- University of Ghana School of Public Health, Accra, Ghana.
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Hyle EP, Bekker L, Martey EB, Huang M, Xu A, Parker RA, Walensky RP, Middelkoop K. Cardiovascular risk factors among ART-experienced people with HIV in South Africa. J Int AIDS Soc 2019; 22:e25274. [PMID: 30990252 PMCID: PMC6466898 DOI: 10.1002/jia2.25274] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/12/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION People with HIV (PWH) are at increased risk for atherosclerotic cardiovascular disease (CVD). Screening for CVD risk factors is recommended but not routine in South African HIV clinics. We sought to describe the prevalence of CVD risk factors among antiretroviral treatment (ART)-experienced patients in South Africa. METHODS We performed a prospective, observational cross-sectional study of PWH (>21 years, excluding pregnant women) on ART in South Africa. We interviewed patients regarding CVD risk factors, and obtained two blood pressure (BP) measurements and random/fasting glucose via a point-of-care glucometer. Standardized chart reviews provided individuals' HIV-specific data. We defined hypertension as: self-reported use of antihypertensives or mean systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg (Stage 1) or SBP ≥160 mmHg or DBP ≥100 mmHg (Stage 2). We defined diabetes as self-reported use of insulin/oral hypoglycaemics or fasting (random) glucose ≥7.0 (≥11.1) mmol. We obtained risk ratios (RR) for hypertension from a multivariable log-binomial regression model, adjusting for age, sex and diabetes. RESULTS From March 2015 to February 2016, 458 participants enrolled with median age 38 years (interquartile range (IQR) 33 to 44 years) and median CD4 466/μL (IQR 317 to 638/μL); 78% were women. Participants were on ART for a median of four years, with 33% on ART ≥6 years. Almost a quarter (106/458) met the study definition for hypertension, of whom 45/106 (42%) were previously diagnosed, 23/45 (51%) were on medication and 4/23 (17%) were controlled. Eight participants had asymptomatic hypertensive urgency (BP≥180/110 mmHg). Of the 458 participants, 26 (6%) met the study definition for diabetes, half of whom (13/26) were already diagnosed; 11/13 (85%) were on treatment, of whom 4/11 (36%) had normal glucose. Age was the only significant predictor of hypertension (RR, 1.04; 95% CI, 1.03 to 1.06, p < 0.0001) in the multivariable model. CONCLUSIONS Hypertension and diabetes were prevalent among PWH prescribed ART in South Africa with less than half diagnosed, and still fewer treated and controlled. Hypertension was independently associated with age but not with HIV-specific factors. Screening for and treatment of CVD risk factors could decrease future morbidity and mortality, especially as this population ages.
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Affiliation(s)
- Emily P Hyle
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMAUSA
- Harvard University Center for AIDS Research (CFAR)BostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Linda‐Gail Bekker
- Desmond Tutu HIV CentreInstitute of Infectious Disease & Molecular Medicine and Department of Medicine Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Emily B Martey
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
| | - Mingshu Huang
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Biostatistics CenterMassachusetts General HospitalBostonMAUSA
| | - Ai Xu
- Biostatistics CenterMassachusetts General HospitalBostonMAUSA
| | - Robert A Parker
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Harvard University Center for AIDS Research (CFAR)BostonMAUSA
- Harvard Medical SchoolBostonMAUSA
- Biostatistics CenterMassachusetts General HospitalBostonMAUSA
| | - Rochelle P Walensky
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMAUSA
- Harvard University Center for AIDS Research (CFAR)BostonMAUSA
- Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesBrigham and Women's HospitalBostonMAUSA
- Division of General Internal MedicineMassachusetts General HospitalBostonMAUSA
| | - Keren Middelkoop
- Desmond Tutu HIV CentreInstitute of Infectious Disease & Molecular Medicine and Department of Medicine Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
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Al Abdi RM, Alshraideh H, Hijazi HH, Jarrah M, Alyahya MS. The use of echocardiographic and clinical data recorded on admission to simplify decision making for elective percutaneous coronary intervention: a prospective cohort study. BMC Med Inform Decis Mak 2019; 19:46. [PMID: 30885191 PMCID: PMC6421658 DOI: 10.1186/s12911-019-0797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD), a leading cause of mortality, affects patient health-related quality of life (HRQoL). Elective percutaneous coronary interventions (ePCIs) are usually performed to improve HRQoL of CAD patients. The aim of this study was to design models using admission data to predict the outcomes of the ePCI treatments on the patients' HRQoL. METHODS This prospective cohort study was conducted with CAD patients who underwent ePCIs at the King Abdullah University Hospital in Jordan from January 2014 through May 2015. Six months after their ePCI procedures, the participants completed the improved MacNew (QLMI-2) questionnaire, which was used for evaluating three domains (physical, emotional and social) of HRQoL. Multivariate linear regression was used to design models to predict the three domains of HRQoL from echocardiographic findings and clinical data that are routinely measured on admission. RESULTS The study included 239 patients who underwent ePCIs and responded to the QLMI-2 questionnaire. The mean age (± standard deviation) of the participants was 55.74 ± 11.84 years, 54.58 ± 11.37 years for males (n = 174) and 59.11 ± 12.49 years for females (n = 65). The average scores for physical, emotional and social HRQoL were 4.38 ± 1.27, 4.4 ± 1.11, and 4.37 ± 1.32, respectively. Out of the 42 factors inputted to the models to predict HRQoL scores, 10, 9, and 9 factors were found to be significant determinants for physical, emotional and social domains, respectively, with adjusted coefficients of determination of 0.630, 0.604 and 0.534, respectively. Basophil levels on admission showed a significant positive correlation with the three domains of HRQoL, while aortic root diameter showed a negative correlation. Scores for the three domains were significantly lower in women than in men. Hypertensive and diabetic patients had significantly lower HRQoL scores than patients without hypertension and diabetes. CONCLUSION The prediction of HRQoL scores 6 months after an ePCI is possible based on data acquired on admission. The models developed here can be used as decision-making tools to guide physicians in identifying the efficacy of ePCIs for individual patients, hence decreasing the rate of inappropriate ePCIs and reducing costs and complications.
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Affiliation(s)
- Rabah M Al Abdi
- Biomedical Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan.
| | - Hussam Alshraideh
- Industrial Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba H Hijazi
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamad Jarrah
- Division of Cardiology, Internal Medicine Department, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Parameters of Bone and Cardiovascular Health Related to 25-Hydroxyvitamin D Status in Emirati Nationals attending Primary Care and Diabetes services: a retrospective cohort study. Sci Rep 2019; 9:3835. [PMID: 30846793 PMCID: PMC6405844 DOI: 10.1038/s41598-019-40523-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 02/14/2019] [Indexed: 12/19/2022] Open
Abstract
Vitamin D deficiency is endemic in people living in the Gulf states. We performed a retrospective analysis of data gathered at the first attendance of 82,396 Emirati nationals to outpatient diabetes, endocrinology and general primary care services at two centres in the United Arab Emirates during 2012–2016. Our aim was to explore associations between vitamin D status and markers of cardiovascular and bone health. In the study population, 67.1% of men and 73.5% of women had serum 25(OH)D of less than 50 nmol/L, with the lowest levels being found in young adults. Among Emirati adults with type 2 diabetes, serum 25(OH)D < 50 nmol/L was associated with an increased risk of a coexisting adverse total cholesterol:HDL (TC:HDL) ratio (odds ratio 2.13 (1.60–2.84), p < 0.001). Correcting for age, sex, body mass index, HbA1c and statin therapy, an increase in 25(OH)D of 1 nmol/L was associated with a 0.01 unit reduction in TC:HDL in this population. In a subset of 1064 adult individuals, 25(OH)D < 25 nmol/L was associated with a reduction in DEXA-measured z-score of −0.29 (−0.44 to −0.15, p < 0.001) at the femoral neck and of −0.25(−0.45 to −0.05, p = 0.015) at L1–4, corrected for body mass index, compared with individuals with 25(OH)D ≥ 75 nmol/L. Our findings raise concerns regarding lifetime burden of cardiovascular disease and bone health for young Emiratis with vitamin D deficiency.
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Al-Shamkhani W, Ayetey H, Lip GYH. Atrial fibrillation in the Middle East: unmapped, underdiagnosed, undertreated. Expert Rev Cardiovasc Ther 2018; 16:341-348. [PMID: 29575965 DOI: 10.1080/14779072.2018.1457953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the commonest persistent cardiac arrhythmia with an estimated incidence rate of between 1.5-2% and an important cause of strokes. Few epidemiological studies and clinical trials on the management of AF have been conducted outside Europe and North America. These gaps in our understanding of AF likely lead to sub-optimal management of patients with AF in the rest of the world. Areas covered: We discuss the epidemiology, treatment and clinical outcomes for AF in the Middle East after systematic review of published work for AF from the Middle East. We also discuss important clinical trials on AF conducted in the West in the same period to help contextualize our findings. Expert commentary: The few available Middle East studies suggest important epidemiological differences between Middle Eastern and Western AF populations. In particular, the Middle Eastern AF population is younger and have more co-morbidities than patients in the West. We find that significant numbers of moderate to high risk patients with AF are either undertreated or untreated placing them at increased risk of complications such as stroke. More studies in the Middle Eastern population are required to aid the development of region-specific clinical guidelines to improve patient care.
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Affiliation(s)
- Warkaa Al-Shamkhani
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK
| | - Harold Ayetey
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK
| | - Gregory Y H Lip
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK.,b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
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