Socio-economic variations in the clinical presentation, etiology and outcome of infective endocarditis in the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry: a prospective cohort study

Background

Infective endocarditis (IE) is a life threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors may influence variations in epidemiology, clinical presentation, investigation and management (and their consequence upon clinical outcomes) in a large international multi-centre registry.

Methods

The ESC-EORPEURO-ENDO registry comprises a prospective cohort of 3116 adult patients admitted to 156 hospitals in 40 countries with IE between January 2016 and March 2018. We analysed the complete dataset to assess potentially important determinants of variation according to World Bank economic stratification (high income (Group 1) [73.8%]; upper-middle income (Group 2) [17.1%]; lower-middle income (Group 3)[9.1%]).

Results

Patients in Group 3 were younger (median age [IQR]: Group 1 - 66 [54–75] years; Group 2 - 57 [40–68] years; Group 3 - 33 [26–43] years; p<0.001) with a higher prevalence of smoking, intravenous drug use and human immunodeficiency virus (HIV) infection (all p<0.001). Group 3 patients with IE presented later (median [IQR) days since symptom onset: Group 1 - 12 [3–35]; Group 2 - 20 [6–51]; Group 3 - 31 [12–62]; p<0.001) and were more likely to develop congestive heart failure (13.6%; 11.3%; and 22.6%, respectively; p<0.001), septic shock (8.3%; 11.1%; 13.4%; p=0.007), and persistent fever for greater than 7 days (9.6%; 14.4%; 27.9%; p<0.001) following hospital admission. Surgery was performed less frequently in Group 3 (75.4%, 76.8% and 51.3% in Groups 1, 2 and 3, respectively; p<0.001) and mortality was highest in the poorest countries (14.6%; 23.6% and 23.7%, respectively; p<0.001).

Conclusion

Socio-economic factors influence the clinical profile of patients presenting with IE across the world. Despite being younger, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and less frequent use of surgery.

Funding Acknowledgement

Type of funding sources: None.

Benefit-incidence analysis of government spending on Ministry of Health outpatient services in Jordan

A benefit-incidence analysis was conducted for the year 2000 using various data sources including the Jordan healthcare utilization and expenditure survey 2000. The results illustrate that the poorest segment of the Jordanian population were the most likely to report sickness and seek treatment and were the main users of the Ministry of Health outpatient services. The poorest uninsured individuals were the main source of revenues generated through user fees. The targeting efficiency (i.e. total percentage of benefits received) for the poorest quintile was 33.8% compared with 4.0% in the richest quintile. The analysis demonstrates that the Jordanian government in-kind subsidy is reaching the poor.

Pacing for hypertrophic obstructive cardiomyopathy does it work?

Sixty-nine years old lady presented with sudden cardiac arrest, she was found to have hypertrophic obstructive cardiomyopathy, she refused septal myomectomy and had a dual chamber ICD implanted, she was put on right ventricular apical pacing with short AV interval, after pacing her max pressure gradient across left ventricular out flow tract (LVOT) dropped from 117 mmHg to 21 mmHg and her symptoms much improved over a follow up period of 1 year.

Novel pyridazine derivatives: Synthesis and antimicrobial activity evaluation

A general method for the preparation of new hydrazones is reported. The 1-[4-(2-methoxybenzyl)-6-aryl pyridazin-3(2H)-ylidene] hydrazines or their tautomeric structures (1(a-d)) were condensed with different aldehydes, dialdehydes, ketones, alpha-dicarbonyl compounds and simple carbohydrates to afford the hydrazones and dihydrazones (2(a-d)), (3(a-d)), (4(a-d)), (5(a-d)), (6(d)), (7(c)), (8(a-d)), (9(a-d)), (10(a-d)), (11(a-d)), (12(a,c,d)), (13(a-d)), (14(a-d)), (15(a-d)), (16(a-d)) and (17(a-d)). The structures of all synthesized compounds were confirmed from microanalytical and spectral data. Some of the products were screened for their antimicrobial activity against Staphylococcus aureus and Streptococcus faecalis, Escherichia coli and Pseudomonas aeruginosa. The hydrazone derivative 15(d) (1-[4-(2-methoxybenzyl)-6-methylphenyl pyridazin-3(2H)-ylidene]-2-(2-carboxydiphenyl methyl) hydrazine) showed the highest biological activity.