Role of Coenzyme Q10 in Prophylaxis of Myocardial Infarction

Introduction: Coenzyme Q10 (CoQ10) has a potential role in reducing the risk of myocardial infarction by slowing the progression of atherosclerosis and improving ischemia. In this study, we will assess the role of coenzyme Q10 in prophylaxis for reducing myocardial infarction and mortality related to myocardial infarction.

Methods: This open-label two open placebo-controlled randomized clinical trial was conducted in a tertiary care hospital in Sukkur, Pakistan from April 2016 to September 2019. Eight hundred nighty-two (892) patients with clinically diagnosed and documented evidence of hypertension were enrolled in the study from the outpatient department. Participants were randomized into two groups by 1:1 ratio using an online randomizer software, Research Randomizer (https://www.randomizer.org/). Group A received 100 mg coenzyme Q10 daily (coenzyme Q10 group) in addition to standard therapy and group B received standard therapy only (placebo group).

Results: Participants who received coenzyme Q10 had fewer incidence of non-fatal myocardial infarction over 12 months (5.4% vs 8.4%) with relative risk reduction of 2.92 (confidence interval 95%, 0.55-2.76). The number needed to treat to prevent one non-fatal myocardial infarction was 34. Participants who received coenzyme Q10 had fewer incidence of fatal myocardial infarction over 12 months (1.5% vs 3.1%) with relative risk reduction of 1.65 (confidence interval 95%, 0.39-3.69). Number needed to treat to prevent one fatal myocardial infarction was 60.

Conclusion: According to this study, coenzyme Q10 reduced the incidence of fatal and non-fatal myocardial infarctions. Clinicians should consider adding coenzyme Q10 to the treatment regimen of high-risk patients of myocardial infarction. We suggest coenzyme Q10 may be an effective prophylactic agent in patients at risk of myocardial infarction and it may help in reducing burden on the health care system.

Effect of Monthly 100,000 IU Vitamin D Supplementation on Falls and Non-Vertebral Fractures

Introduction

Correlation between decreased levels of vitamin D in the blood of elderly patients and incidence of falls and fractures has been assessed in various studies; however, there is still ambiguity in data. In this study, we aim to establish the role of vitamin D supplements in minimizing the burden of falls and non-vertebral fractures in the elderly population in a local setting.

Methods

This single-blind, placebo-controlled randomized interventional study was conducted in the Internal Medicine Department of a tertiary care hospital in Pakistan from March 2018 to July 2020. Patients between the ages of 50 to 75 years were enrolled in the study and were randomly assigned to receive either placebo or 100,000 IU vitamin D oral tablets and were followed over 24 months, with regular follow-ups every three months.

Results

There was no significant difference in the probability of one or more falls for those assigned to the vitamin D group compared to those who received placebo (24.70% vs. 24.85%; hazard ratio [HR]: 0.99; 95% CI: 0.68-1.43). Similarly, the probability of non-vertebral fracture was also non-significant between both groups (4.7% vs. 5.7%; HR: 0.81; 95% CI: 0.32-2.01).

Conclusion

As per the results of this study, vitamin D supplementation had no beneficial effect on the reduction of falls and non-vertebral fractures in elderly patients. Further multi-center studies of longer duration are required to prove the favorable effects of vitamin D supplements.

Assessment of Clinical Empathy Among Medical Students Using the Jefferson Scale of Empathy-Student Version

Introduction

Clinical empathy is the ability to comprehend the perspectives, feelings, and situation of the patients. Clinical empathy instills a sense of satisfaction in the patient. It also facilitates the healthcare provider (HCPs) in taking more sincere and logical clinical decisions. Although there have been numerous studied conducted to explore the pattern of clinical empathy among medical students, the results are mixed and not consistent.

Methods

This is a cross-sectional, observational study conducted among medical students of Ghulam Muhammad Mahar Medical College in August 2018. Two hundred and seven out of 500 students of all five years completed the study after informed consent. All students completed the 20-item Jefferson Scale of Empathy-Student Version (JSE-S). Data were entered and analyzed using SPSS version 22 (SPSS Inc, Chicago, IL, USA). The internal consistency of JSE-S was 0.71. Frequencies and percentages were calculated for students’ ages and genders. Mean and standard deviation (SD) were calculated for continuous variables. Group comparisons of the empathy scores were conducted using t-test and one-way analysis of variance (ANOVA). p<0.05 was considered as the significant level.

Results

There were 93 (44.9%) male and 114 (55.1%) female students. Their mean ± SD age was 20.85 ± 2.27 years (range: 17 to 26 years). The mean ± SD empathy score of all students was 98.11 ± 12.31 (range: 20-140). The mean empathy score was categorized according to gender, year of education, and career preference. Females showed a significantly higher empathy score. The lowest empathy was seen for the final year and the highest for the first year. On all three subscales of (JSE-S) - perspective taking, compassionate care, and walking in patients’ shoes - students with “people-oriented” career preference scored higher.

Conclusion

JSE-S is a self-administered and self-perceived inventory, which reports declining empathy in medical students with ascending years of education. Qualitative studies that can assess the empathy levels from the patients’ perspective are the need of the hour to decide whether or not empathy is a real phenomenon.

Frequency of Depression and Anxiety Symptoms in Surgical Hospitalized Patients

Background Patients hospitalized for surgeries and those with chronic remitting health conditions develop hospital-induced anxiety and depression. Unfamiliar hospital environment, insufficient privacy, exposure to strange instruments, financial concerns, disease stress, and prolonged hospital stay contribute to this anxiety. The aim of this study was to assess the frequency of depression and anxiety in surgical patients. Material and methods This observational study was conducted among 50 patients hospitalized for 10 days or more in the surgical unit. All patients completed the Hospital Anxiety and Depression Scale (HADS). It has seven items for anxiety and depression each. Each item scores 0-3. A subscale score >8 denotes anxiety or depression. Data were entered and analyzed using SPSS v.20. Mean and standard deviation (SD) were calculated for descriptive data, and frequencies and percentages were calculated for categorical data. Results On the HADS, the mean ± SD score of anxiety was 11.84 ± 4.16 and that of depression was 12.78 ± 4.16. There were 64% severely anxious and 74% severely depressed hospitalized patients. More patients with less than two weeks of hospital stay were severely depressed than severely anxious (72.7% vs. 36.3%). There were 20% patients with moderate anxiety and depression with hospital stay longer than three weeks and 80% with severe anxiety and depression. Conclusion There is a high incidence of anxiety and depression in surgical patients. Patients at risk of developing these symptoms must be identified and psychological care should be provided to them.