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Al Hanaei A, AlKindi F, Alkhemeiri A, Nair SC. Gastrointestinal Bleeding in COVID-19 Infected Patients, and Management Outcomes. Int J Gen Med 2024; 17:1145-1153. [PMID: 38559591 PMCID: PMC10981877 DOI: 10.2147/ijgm.s454841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Gastrointestinal bleeding in COVID-19-infection poses unique challenges to patients owing to the high risk of concomitant respiratory failure. However, endoscopic care providers are prone to transmission. This study aimed to understand the risk and management outcomes of gastrointestinal bleeding in COVID-19-infected patients. Methods Data were abstracted from electronic patient medical records, using ICD 10 codes, and demographic and clinical data were collected, for COVID-19-infected patients who developed gastrointestinal (GI) bleeding. Complications related to COVID-19 infection and management outcomes of GI bleeding were studied. Statistically, descriptive analysis was used because of the small sample size. Results Eighteen COVID-19-infected patients developed episodes of GI bleeding, yielding a prevalence of 0.45%. Their mean age was 74.8 years, 55.5% were female, and 66.6% of patients (n=12) had upper GI bleeding symptoms, predominantly melena (55.5%), followed by coffee ground nasogastric aspirates (n=2). Only two patients (11.11%) had episodes of lower GI bleeding, and the remaining four patients (22.2%) had recurrent acute anemia requiring blood transfusion. The Glasgow-Blatchford score (GBS) at presentation ranged between 6 to 16 (mean 8.8) and seven patients (38.8%) underwent endoscopic evaluation for GI bleeding. The predominant comorbid conditions included hypertension (22.2%), diabetes mellitus (27.7%), chronic kidney disease (50%), ischemic heart disease (33%), atrial fibrillation (11.1%), and peripheral vascular disease (11.1%). The median hospitalization was 24.6 days (range: 3-54 days). The 30-day mortality rate in our cohort was 22.2%, (4/18) mainly noted in older patients aged> 60 years with comorbid conditions and severe COVID-19 infection. Conclusion The prevalence of GI bleeding observed in our cohort was approximately 0.45%, significantly lower than the global prevalence observed, majority (66%) had upper GI bleeding. The exact reasons for the observed low prevalence of GI bleeding cannot be explained and will be the subject of future research.
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Affiliation(s)
- Amnah Al Hanaei
- Division of Gastroenterology, Tawam Hospital, Al Ain, Emirate of Abu Dhabi, United Arab Emirates
| | - Fatima AlKindi
- Department of Internal Medicine, Tawam Hospital, Al Ain, Emirate of Abu Dhabi, United Arab Emirates
| | - Aysha Alkhemeiri
- Department of Internal Medicine, Tawam Hospital, Al Ain, Emirate of Abu Dhabi, United Arab Emirates
| | - Satish Chandrasekhar Nair
- Department of Academic Affairs, Tawam Hospital & the College of Medicine UAE University, Al Ain, Emirate of Abu Dhabi, United Arab Emirates
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Alsaadi T, Almadani A, Al-Hashel J, Al Salti A, Melikyan G, Khan RA. Commentary: Consensus Guidelines on the Appropriate Use of Brand-Name and Generic Anti-Seizure Medication for the Management of Epilepsy in the Gulf Region. Neurol Ther 2023; 12:1015-1031. [PMID: 37222860 PMCID: PMC10310631 DOI: 10.1007/s40120-023-00491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION The clinical, social, and economic burden of epilepsy is undeniable. Local guidance on epilepsy management is limited and needed to address the both use of anti-seizure medication (ASM) and switching practices which influence clinical outcomes. AREAS COVERED An expert panel composed of practicing neurologists and epileptologists from countries of the Gulf Cooperation Council (GCC) met in 2022 to discuss local challenges in the management of epilepsy and formulate recommendations for clinical practice. Published literature on the outcomes of ASM switching was reviewed along with clinical practice/gaps, international guidelines, and local treatment availabilities. EXPERT OPINION Improper ASM use and inappropriate brand-name-to-generic or generic-to-generic switching can contribute to worsening clinical outcomes in epilepsy. ASMs should be used for the management of epilepsy based on patient clinical profile, underlying epilepsy syndrome, and drug availability to ensure optimal and sustainable treatment. Both first-generation and newer ASMs can be considered; appropriate use is recommended from the beginning of treatment. It is critical to avoid inappropriate ASM switching to avoid breakthrough seizures. All generic ASMs should fulfill strict regulatory requirements. If needed, ASM changes should always be approved by the treating physician. ASM switching (brand-name-to-generic, generic-to-generic, generic-to-brand-name) should be avoided in epilepsy patients who have achieved control but can be considered for those uncontrolled on current medication.
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Affiliation(s)
- Taoufik Alsaadi
- Neurology Department, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | | | - Jasem Al-Hashel
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Gayane Melikyan
- Neurology, Weill Cornell Medical College-Qatar (WCMC-Q), Ar-Rayyan, Qatar
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Daoulah A, Baqais RT, Aljohar A, Alhassoun A, Hersi AS, Almahmeed W, Yousif N, Alasmari A, Alshehri M, Eltaieb F, Alzahrani B, Elmahrouk A, Arafat AA, Jamjoom A, Alshali KZ, Abuelatta R, Ahmed WA, Alqahtani AH, Al Garni T, Hashmani S, Dahdouh Z, Refaat W, Kazim HM, Ghani MA, Amin H, Hiremath N, Elmahrouk Y, Selim E, Aithal J, Qutub MA, Alama MN, Ibrahim AM, Elganady A, Abohasan A, Asrar FM, Farghali T, Naser MJ, Hassan T, Balghith M, Hussien AF, Abdulhabeeb IA, Ahmad O, Ramadan M, Ghonim AA, Shawky AM, Noor HA, Haq E, Alqahtani AM, Al Samadi F, Abualnaja S, Khan M, Alhamid S, Lotfi A. Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting. Kidney Blood Press Res 2023; 48:545-555. [PMID: 37517398 PMCID: PMC10614553 DOI: 10.1159/000533141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. METHODS This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19-15.76], p < 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79-3.73]; p < 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71-1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90-1.39], p = 0.312). CONCLUSIONS PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function.
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Rasha Taha Baqais
- Department of Cardiac Surgery, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Alwaleed Aljohar
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarim Alhassoun
- Department of Anesthesia, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Ahmad S. Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Saudi Arabia
| | - Fakhreldein Eltaieb
- Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr A. Arafat
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Khalid Z. Alshali
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Waleed A. Ahmed
- Department of Medicine, Security Forces Hospital, Mecca, Saudi Arabia
| | | | - Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Shahrukh Hashmani
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Wael Refaat
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | | | | | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Niranjan Hiremath
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | - Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City, UAE
| | - Mohammed A. Qutub
- Department of Medicine, Cardiology Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed N. Alama
- Department of Medicine, Cardiology Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M. Ibrahim
- Department of Cardiology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
- Department of Cardiology, Faculty of Medicine, Alazhr University, Cairo, Egypt
| | - Abdulwali Abohasan
- Department of cardiology, Prince Sultan Cardiac Center, Qassim, Saudi Arabia
| | - Farhan M. Asrar
- Department of Family and Community Medicine, Faculty of Medicine and Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Credit Valley Family Medicine Teaching Unit and Summerville Family Medicine Teaching Unit, Trillium Health Partners and University of Toronto, Mississauga, ON, Canada
| | - Tarek Farghali
- Department of Cardiology, Saudi German Hospital, Ajman, UAE
| | - Maryam Jameel Naser
- Department of Internal Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Taher Hassan
- Department of Cardiology, Bugshan General Hospital, Jeddah, Saudi Arabia
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | | | | | - Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Ahmed A. Ghonim
- Department of Medicine, Cardiology Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abeer M. Shawky
- Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
- Department of Cardiology, Faculty of Medicine, Alazhr University, Cairo, Egypt
| | - Husam A. Noor
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Ejazul Haq
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Abdulrahman M. Alqahtani
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Faisal Al Samadi
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Seraj Abualnaja
- Department of Cardiology, International Medical Center, Jeddah, Saudi Arabia
| | - Mushira Khan
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Sameer Alhamid
- Department of Emergency Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amir Lotfi
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School, Baystate Medical Center, Springfield, MA, USA
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Daoulah A, Alqahtani AH, Elmahrouk A, Yousif N, Almahmeed W, Arafat AA, Al Garni T, Qutub MA, Dahdouh Z, Alshehri M, Hersi AS, Malak MM, Djunaedi SR, Zaidi A, Naser MJ, Qenawi W, Elganady A, Hassan T, Ball V, Elmahrouk Y, Hussien AF, Alzahrani B, Abuelatta R, Selim E, Jamjoom A, Alshali KZ, Hashmani S, Refaat W, Kazim HM, Ghani MA, Amin H, Ibrahim AM, Abohasan A, Alama MN, Balghith M, Abdulhabeeb IAM, Ahmad O, Ramadan M, Ghonim AA, Shawky AM, Noor HA, Alqahtani AM, Al Samadi F, Abualnaja S, Baqais RT, Alhassoun A, Altnji I, Khan M, Alasmari A, Aljohar A, Hiremath N, Aithal J, Lotfi A. Percutaneous coronary intervention vs. coronary artery bypass grafting in emergency and non-emergency unprotected left-main revascularization. Eur J Med Res 2023; 28:210. [PMID: 37393361 DOI: 10.1186/s40001-023-01189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND The optimal revascularization strategy in patients with left main coronary artery (LMCA) disease in the emergency setting is still controversial. Thus, we aimed to compare the outcomes of percutaneous coronary interventions (PCI) vs. coronary artery bypass grafting (CABG) in patients with and without emergent LMCA disease. METHODS This retrospective cohort study included 2138 patients recruited from 14 centers between 2015 and 2019. We compared patients with emergent LMCA revascularization who underwent PCI (n = 264) to patients who underwent CABG (n = 196) and patients with non-emergent LMCA revascularization with PCI (n = 958) to those who underwent CABG (n = 720). The study outcomes were in-hospital and follow-up all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Emergency PCI patients were older and had a significantly higher prevalence of chronic kidney disease, lower ejection fraction, and higher EuroSCORE than CABG patients. CABG patients had significantly higher SYNTAX scores, multivessel disease, and ostial lesions. In patients presenting with arrest, PCI had significantly lower MACCE (P = 0.017) and in-hospital mortality (P = 0.016) than CABG. In non-emergent revascularization, PCI was associated with lower MACCE in patients with low (P = 0.015) and intermediate (P < 0.001) EuroSCORE. PCI was associated with lower MACCE in patients with low (P = 0.002) and intermediate (P = 0.008) SYNTAX scores. In non-emergent revascularization, PCI was associated with reduced hospital mortality in patients with intermediate (P = 0.001) and high (P = 0.002) EuroSCORE compared to CABG. PCI was associated with lower hospital mortality in patients with low (P = 0.031) and intermediate (P = 0.001) SYNTAX scores. At a median follow-up time of 20 months (IQR: 10-37), emergency PCI had lower MACCE compared to CABG [HR: 0.30 (95% CI 0.14-0.66), P < 0.003], with no significant difference in all-cause mortality between emergency PCI and CABG [HR: 1.18 (95% CI 0.23-6.08), P = 0.845]. CONCLUSIONS PCI could be advantageous over CABG in revascularizing LMCA disease in emergencies. PCI could be preferred for revascularization of non-emergent LMCA in patients with intermediate EuroSCORE and low and intermediate SYNTAX scores.
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, P.O. Box: 40047, Jeddah, 21499, Kingdom of Saudi Arabia.
| | - Abdulrahman H Alqahtani
- Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, P.O. Box: 40047, Jeddah, 21499, Kingdom of Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Amr A Arafat
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed A Qutub
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmad S Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Majed M Malak
- Department of Medicine, King Abdulaziz University, Rabigh, Kingdom of Saudi Arabia
| | - Syifa R Djunaedi
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, 01199, USA
| | - Ayesha Zaidi
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, 01199, USA
| | - Maryam Jameel Naser
- Department of Medicine, Baystate Medical Center, 759 Chestnut St, Springfield, MA, USA
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, Dr. Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Taher Hassan
- Department of Cardiology, Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Vincent Ball
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Adnan Fathey Hussien
- Department of Cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, P.O. Box: 40047, Jeddah, 21499, Kingdom of Saudi Arabia
| | - Khalid Z Alshali
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Shahrukh Hashmani
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Wael Refaat
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Hameedullah M Kazim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Mohamed Ajaz Ghani
- Department of Cardiology, Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Ahmed M Ibrahim
- Department of Cardiology, Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdulwali Abohasan
- Department of Cardiology, Prince Sultan Cardiac Center, Qassim, Kingdom of Saudi Arabia
| | - Mohamed N Alama
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim A M Abdulhabeeb
- Department of Cardiology, King Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia
| | - Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ahmed A Ghonim
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abeer M Shawky
- Department of Cardiology, Dr. Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Husam A Noor
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Abdulrahman M Alqahtani
- Department of Cardiology, King Fahad Medical City, King Salman Heart Center, Riyadh, Kingdom of Saudi Arabia
| | - Faisal Al Samadi
- Department of Cardiology, King Fahad Medical City, King Salman Heart Center, Riyadh, Kingdom of Saudi Arabia
| | - Seraj Abualnaja
- Department of Cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Rasha Taha Baqais
- Department of Cardiac Surgery, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdulkarim Alhassoun
- Department of Anesthesia, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Issam Altnji
- Department of Cardiology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Mushira Khan
- Al Faisal University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, P.O. Box: 40047, Jeddah, 21499, Kingdom of Saudi Arabia
| | - Alwaleed Aljohar
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Niranjan Hiremath
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City A, UAE
| | - Amir Lotfi
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, 01199, USA
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Alahmad B, Li J, Achilleos S, Al-Mulla F, Al-Hemoud A, Koutrakis P. Burden of fine air pollution on mortality in the desert climate of Kuwait. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00565-7. [PMID: 37322149 PMCID: PMC10403355 DOI: 10.1038/s41370-023-00565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Middle Eastern desert countries like Kuwait are known for intense dust storms and enormous petrochemical industries affecting ambient air pollution. However, local health authorities have not been able to assess the health impacts of air pollution due to limited monitoring networks and a lack of historical exposure data. OBJECTIVE To assess the burden of PM2.5 on mortality in the understudied dusty environment of Kuwait. METHODS We analyzed the acute impact of fine particulate matter (PM2.5) on daily mortality in Kuwait between 2001 and 2016. To do so, we used spatiotemporally resolved estimates of PM2.5 in the region. Our analysis explored factors such as cause of death, sex, age, and nationality. We fitted quasi-Poisson time-series regression for lagged PM2.5 adjusted for time trend, seasonality, day of the week, temperature, and relative humidity. RESULTS There was a total of 70,321 deaths during the study period of 16 years. The average urban PM2.5 was estimated to be 46.2 ± 19.8 µg/m3. A 10 µg/m3 increase in a 3-day moving average of urban PM2.5 was associated with 1.19% (95% CI: 0.59, 1.80%) increase in all-cause mortality. For a 10 µg/m3 reduction in annual PM2.5 concentrations, a total of 52.3 (95% CI: 25.7, 79.1) deaths each year could be averted in Kuwait. That is, 28.6 (95% CI: 10.3, 47.0) Kuwaitis, 23.9 (95% CI: 6.4, 41.5) non-Kuwaitis, 9.4 (95% CI: 1.2, 17.8) children, and 20.9 (95% CI: 4.3, 37.6) elderly deaths each year. IMPACT STATEMENT The overwhelming prevalence of devastating dust storms and enormous petrochemical industries in the Gulf and the Middle East has intensified the urgency to address air pollution and its detrimental health effects. Alarmingly, the region's epidemiological research lags behind, hindered by a paucity of ground monitoring networks and historical exposure data. In response, we are harnessing the power of big data to generate predictive models of air pollution across time and space, providing crucial insights into the mortality burden associated with air pollution in this under-researched yet critically impacted area.
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Affiliation(s)
- Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Environmental & Occupational Health Department, College of Public Health, Kuwait University, Kuwait City, Kuwait.
- Dasman Diabetes Institute, Kuwait City, Kuwait.
| | - Jing Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Souzana Achilleos
- Department of Primary Care & Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Ali Al-Hemoud
- Environment & Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait City, Kuwait
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Daoulah A, Jameel Naser M, Hersi A, Yousif N, Alasmari A, Almahmeed W, AlZahrani HA, Aljohar A, Alshehri M, Alzahrani B, Basudan D, Alosaimi H, Abuelatta R, Al Garni T, Ghani MA, Amin H, Noor HA, Hashmani S, Al Nasser FOM, Kazim HM, Wael Refaat WR, Selim E, Jamjoom A, El-Sayed O, Hassan T, Dahdouh Z, Aithal J, Diab A, Ibrahim AM, Elganady A, Qutub MA, Alama MN, Abohasan A, Tawfik W, Balghith M, Abualnaja S, Fathey Hussien A, Abdulhabeeb IAM, Ahmad O, Ramadan M, Alqahtani AH, Al Samadi F, Qenawi W, Shawky A, Ghonim AA, Arafat AA, Elmahrouk A, Elmahrouk Y, Hiremath N, Shawky AM, Asrar FM, Farghali T, Altnji I, Aljohani K, Alotaiby M, Alqahtani AM, Lotfi A. Outcomes of Left Main Revascularization in Patients with Anemia: Gulf Left Main Registry. Cardiology 2023; 148:173-186. [PMID: 36966525 DOI: 10.1159/000530305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/20/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the effects of baseline anemia and anemia following revascularization on outcomes in patients with unprotected left main coronary artery (ULMCA) disease. METHODS This was a retrospective, multicenter, observational study conducted between January 2015 and December 2019. The data on patients with ULMCA who underwent revascularization through percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) were stratified by the hemoglobin level at baseline into anemic and non-anemic groups to compare in-hospital events. The pre-discharge hemoglobin following revascularization was categorized into very low (<80 g/L for men and women), low (≥80 and ≤119 g/L for women and ≤129 g/L for men), and normal (≥130 g/L for men and ≥120 g/L for women) to assess impact on follow-up outcomes. RESULTS A total of 2,138 patients were included, 796 (37.2%) of whom had anemia at baseline. A total of 319 developed anemia after revascularization and moved from being non-anemic at baseline to anemic at discharge. There was no difference in hospital major adverse cardiac and cerebrovascular event (MACCE) and mortality between CABG and PCI in anemic patients. At a median follow-up time of 20 months (interquartile range [IQR]: 27), patients with pre-discharge anemia who underwent PCI had a higher incidence of congestive heart failure (CHF) (p < 0.0001), and those who underwent CABG had significantly higher follow-up mortality (HR: 9.85 (95% CI: 2.53-38.43), p = 0.001). CONCLUSION In this Gulf LM study, baseline anemia had no impact upon in-hospital MACCE and total mortality following revascularization (PCI or CABG). However, pre-discharge anemia is associated with worse outcomes after ULMCA disease revascularization, with significantly higher all-cause mortality in patients who had CABG, and a higher incidence of CHF in PCI patients, at a median follow-up time of 20 months (IQR: 27).
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Maryam Jameel Naser
- Department of Internal Medicine, Baystate Medical Center, Boston, Massachusetts, USA
| | - Ahmad Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Bahrain
| | - Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Hazza A AlZahrani
- Oncology Center, Section of Hematology, Stem Cell Transplantation & Cellular Therapy, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Alwaleed Aljohar
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Saudi Arabia
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Duna Basudan
- Department of Hematology and Oncology, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Hind Alosaimi
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | | | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Bahrain
| | - Husam A Noor
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Bahrain
| | - Shahrukh Hashmani
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | | | | | - Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Osama El-Sayed
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Taher Hassan
- Department of Cardiology, Bugshan General Hospital, Jeddah, Saudi Arabia
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City A, Abu Dhabi, United Arab Emirates
| | - Ahmed Diab
- Department of Cardiology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Ahmed M Ibrahim
- Department of Cardiology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
| | | | - Mohamed N Alama
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulwali Abohasan
- Department of cardiology, Prince Sultan Cardiac Center, Qassim, Saudi Arabia
| | - Wael Tawfik
- Department of Cardiology, Bugshan General Hospital, Jeddah, Saudi Arabia
- Department of Cardiology, Benha University, Benha, Egypt
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Seraj Abualnaja
- Department of Cardiology, International Medical Center, Jeddah, Saudi Arabia
| | | | | | - Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | | | - Faisal Al Samadi
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Saudi Arabia
| | - Ahmed Shawky
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Saudi Arabia
| | - Ahmed A Ghonim
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amr A Arafat
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | | | - Niranjan Hiremath
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Abeer M Shawky
- Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
| | - Farhan M Asrar
- Department of Family and Community Medicine, Faculty of Medicine and Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Credit Valley Family Medicine Teaching Unit and Summerville Family Medicine Teaching Unit, Trillium Health Partners and University of Toronto, Mississauga, Ontario, Canada
| | - Tarek Farghali
- Department of Cardiology, Saudi German Hospital, Ajman, United Arab Emirates
| | - Issam Altnji
- Department of Cardiology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Khalid Aljohani
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alotaiby
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulrahman M Alqahtani
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amir Lotfi
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, Massachusetts, USA
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Daoulah A, Abozenah M, Alshehri M, Hersi AS, Yousif N, Garni TA, Abuelatta R, Almahmeed W, Alasmari A, Alzahrani B, Ghani MA, Amin H, Hashmani S, Hiremath N, Alharbi AW, Kazim HM, Refaat W, Selim E, Dahdouh Z, Aithal J, Ibrahim AM, Elganady A, Qutub MA, Alama MN, Abohasan A, Hassan T, Balghith M, Hussien AF, Abdulhabeeb IAM, Ahmad O, Ramadan M, Alqahtani AH, Ahmed FA, Qenawi W, Shawky A, Ghonim AA, Jamjoom A, El-Sayed O, Elmahrouk A, Elfarnawany A, Elsheikh-Mohamed NE, Abumelha BK, Shawky AM, Arafat AA, Naser MJ, Elmahrouk Y, Alhamid S, Lotfi A. Unprotected Left Main Revascularization in the Setting of Non-Coronary Atherosclerosis: Gulf Left Main Registry. Curr Probl Cardiol 2022; 48:101424. [PMID: 36167223 DOI: 10.1016/j.cpcardiol.2022.101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in revascularization of left main coronary artery (LMCA) disease has been evaluated in previous studies. However, there has been minimal study of the relationship between co-existing non-coronary atherosclerosis (NCA) and LMCA disease revascularization. We aim to examine this relationship. METHODS The Gulf-LM study is a retrospective analysis of unprotected LMCA revascularization cases undergoing PCI with second generation drug-eluting stent versus CABG across 14 centers within 3 Gulf countries between January 2015 and December 2019. A total of 2138 patients were included, 381 with coexisting NCA and 1757 without. Outcomes examined included major adverse cardiovascular and cerebrovascular events (MACCE), cardiac and non-cardiac death, and all bleeding. RESULTS In patients with NCA, preexisting myocardial infarction and congestive heart failure were more common, with PCI being the most common revascularization strategy. A statistically significant reduction in in-hospital MACCE and all bleeding was noted in patients with NCA undergoing PCI as compared to CABG. At a median follow-up of 15 months, MACCE and major bleeding outcomes continued to favor the PCI group, though no such difference was identified between revascularization strategies in patients without NCA. CONCLUSIONS In this multicenter retrospective study of patients with and without NCA who require revascularization (PCI and CABG) for unprotected LMCA disease, PCI demonstrated a better clinical outcome in MACCE both in-hospital and during the short-term follow-up in patients with NCA. However, no such difference was observed in patients without NCA.
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.
| | - Mohammed Abozenah
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, Massachusetts 01199
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmad S Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center, Madinah, kingdom of Saudi Arabia
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, UAE
| | - Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ajaz Ghani
- Department of Cardiology, Madinah Cardiac Center, Madinah, kingdom of Saudi Arabia
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | | | | | - Ahmad W Alharbi
- Department of of Internal Medicine, Gastroenterology Section, Gastroenterologist & Advanced Therapeutic Endoscopist, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Hameedullah M Kazim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Wael Refaat
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City A, Abu Dhabi, UAE
| | - Ahmed M Ibrahim
- Department of Cardiology, Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed A Qutub
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohamed N Alama
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulwali Abohasan
- Department of cardiology, Prince Sultan Cardiac Center, Qassim, Kingdom of Saudi Arabia
| | - Taher Hassan
- Department of Cardiology, Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, kingdom of Saudi Arabia
| | - Adnan Fathey Hussien
- Department of cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Ibrahim A M Abdulhabeeb
- Department of Cardiology, king Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia
| | - Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Abdulrahman H Alqahtani
- Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Fatima Ali Ahmed
- King Abdul Aziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmed Shawky
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmed A Ghonim
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Osama El-Sayed
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia; Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Amr Elfarnawany
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Nezar Essam Elsheikh-Mohamed
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Bader K Abumelha
- Department of Family Medicine, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Abeer M Shawky
- Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Egypt
| | - Maryam Jameel Naser
- Department of Internal Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Springfield, MA
| | | | - Sameer Alhamid
- Department of Emergency Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Amir Lotfi
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, Massachusetts 01199
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Malik RA, Elhadd T, Alattar A, Al Shaikh A, Al Randi M, Arora R, Al-Sifri S, Akil Y, Magdy A, Naqvi M, Hassanein M. Safety and Effectiveness of Insulin Glargine 300 U/mL in Participants with Type 2 Diabetes Who Fast During Ramadan in The Gulf Region: A Subgroup Analysis of the Real-World ORION Study. Diabetes Ther 2022; 13:569-581. [PMID: 35239165 PMCID: PMC8934889 DOI: 10.1007/s13300-022-01225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/04/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION To evaluate the safety and effectiveness of insulin glargine 300 U/mL (Gla-300) in people with type 2 diabetes mellitus (T2DM) in the Gulf region who fast during Ramadan. METHODS ORION was a real-world, prospective, observational study in people with T2DM treated with Gla-300 during pre-Ramadan, Ramadan, and post-Ramadan periods. This subgroup analysis included 222 participants from the Gulf region (Kuwait, Saudi Arabia, United Arab Emirates, and Qatar). The primary endpoint was the percentage of participants experiencing severe and/or symptomatic documented hypoglycemia (self-monitored plasma glucose [SMPG] ≤ 70 mg/dL) during Ramadan. Changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), SMPG, body weight, insulin dose, and adverse events (AEs) were also evaluated. RESULTS The primary endpoint was reported in one (0.5%) participant during Ramadan. The incidence rate of symptomatic documented hypoglycemia (SMPG ≤ 70 mg/dL) decreased from the pre-Ramadan (3.2%) to Ramadan period (0.5%), and no severe hypoglycemia events were reported during the study. Reductions were observed in HbA1c (mean ± standard deviation: - 0.51 ± 0.95% [- 5.5 ± 10.4 mmol/mol]), FPG (- 13.9 ± 47.5 mg/dL), and SMPG (- 6.1 ± 27.1 mg/dL). No significant changes were observed in body weight or Gla-300 dose. AEs were reported in 11 (5.0%) participants. CONCLUSION In a real-world setting in the Gulf region, Gla-300 treatment in people with T2DM during Ramadan was associated with a low incidence of hypoglycemia and improved glycemic control. TRIAL REGISTRATION CTRI/2019/02/017636.
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Affiliation(s)
- Rayaz A Malik
- Weill Cornell Medicine - Qatar, Education City, Doha, Qatar
| | - Tarik Elhadd
- Endocrine Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Muneera Al Randi
- Family Medicine Clinic, New Mowasat Hospital, Salmiya, 22077, Kuwait
| | - Ravi Arora
- NMC Specialty Hospital, Abu Dhabi, United Arab Emirates
| | - Saud Al-Sifri
- Endocrinology Department, Al Hada Military Hospital, Taif, Saudi Arabia
| | | | | | | | - Mohamed Hassanein
- Dubai Hospital, Dubai Health Authority, Al Khaleej Street, Al Baraha, 7272, Dubai, United Arab Emirates.
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Ismail IMI, Rashid MI, Ali N, Altaf BAS, Munir M. Temperature, humidity and outdoor air quality indicators influence COVID-19 spread rate and mortality in major cities of Saudi Arabia. Environ Res 2022; 204:112071. [PMID: 34562487 PMCID: PMC8457907 DOI: 10.1016/j.envres.2021.112071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/13/2021] [Accepted: 09/11/2021] [Indexed: 05/06/2023]
Abstract
There is an increasing evidence that meteorological (temperature, relative humidity, dew) and air quality indicators (PM2.5, PM10, NO2, SO2, CO) are affecting the COVID-19 transmission rate and the number of deaths in many countries around the globe. However, there are contradictory results due to limited observations of these parameters and absence of conclusive evidence on such relationships in cold or hot arid tropical and subtropical desert climate of Gulf region. This is the first study exploring the relationships of the meteorological (temperature, relative humidity, and dew) and air quality indicators (PM10,CO, and SO2) with daily COVID-19 infections and death cases for a period of six months (1st March to August 31, 2020) in six selected cities of the Kingdom of Saudi Arabia by using generalized additive model. The Akaike information criterion (AIC) was used to assess factors affecting the infections rate and deaths through the selection of best model whereas overfitting of multivariate model was avoided by using cross-validation. Spearman correlation indicated that exponentially weighted moving average (EWMA) temperature and relative humidity (R > 0.5, P < 0.0001) are the main variables affecting the daily COVID-19 infections and deaths. EWMA temperature and relative humidity showed non linear relationships with the number of COVID-19 infections and deaths (DF > 1, P < 0.0001). Daily COVID-19 infections showed a positive relationship at temperature between 23 and 34.5 °C and relative humidity ranging from 30 to 60%; a negative relationship was found below and/or above these ranges. Similarly, the number of deaths had a positive relationship at temperature ˃28.7 °C and with relative humidity ˂40%, showing higher number of deaths above this temperature and below this relative humidity rate. All air quality indicators had linear relationships with the number of COVID-19 infections and deaths (P < 0.0001). Hence, variation in temperature, relative humidity and air pollution indicators could be important factors influencing the COVID-19 spread and mortality. Under the current scenario with rising temperature and relative humidity, the number of cases is increasing, hence it justifies an active government policy to lessen COVID-19 infection rate.
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Affiliation(s)
- Iqbal M I Ismail
- Centre of Excellence in Environmental Studies, King Abdulaziz University, P.O Box 80216, Jeddah, 21589, Saudi Arabia; Department of Chemistry, Faculty of Science, King Abdulaziz University, P. O. Box 80203, Jeddah, 21589, Saudi Arabia
| | - Muhammad Imtiaz Rashid
- Centre of Excellence in Environmental Studies, King Abdulaziz University, P.O Box 80216, Jeddah, 21589, Saudi Arabia.
| | - Nadeem Ali
- Centre of Excellence in Environmental Studies, King Abdulaziz University, P.O Box 80216, Jeddah, 21589, Saudi Arabia
| | - Bothinah Abdullah Saeed Altaf
- Department of Statistics, Faculty of Science, Female Campus, King Abdulaziz University, P. O. Box 80203, Jeddah, 21589, Saudi Arabia
| | - Muhammad Munir
- Division of Biomedical and Life Sciences, Lancaster University, United Kingdom
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Abstract
BACKGROUND Optimum glycemic control is necessary to reduce and even prevent the risk of micro- and macrovascular complications of type 1 diabetes mellitus (T1DM). The main aim of this study was to assess the prevalence of T1DM patients with adequate glycemic control in 4 Arabian Gulf countries. METHODS This study was a multicenter, observational, cross-sectional disease registry. Data were collected from adult T1DM patients who were treated with insulin within 6 months prior to the study visit. RESULTS Out of 241 patients whose data were eligible for primary endpoint analysis, 27.4% had adequate glycemic control (HbA1c < 7%). The patients' age ranged from 18 to 64 years, and 53% were males. The mean (SD) duration of diabetes was 14.6 (9) years and the mean HbA1c was 8.11 (1.8) %. At the time of T1DM diagnosis, mean HbA1c was 10.7 (2.17) %. About 98% of the patients were normotensive and the lipid profile of patients was found to be optimal. The main variables associated with adequate glycemic control were low HbA1c at diagnosis (P < 0.001) and absence of a family history of diabetes (P = 0.002). CONCLUSIONS We found that the glycemic control of T1DM adult patients in Kuwait, UAE, Oman and Bahrain is suboptimal. More efforts are necessary to pinpoint the causes of inadequate control in this population.
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Affiliation(s)
- Khadija Hafidh
- Department of Medicine, Rashid Hospital, Dubai Health Authority, Rashid Hospital, P.0.Box 4545, Dubai, UAE.
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Rahman MU, Nair SC, Din MU, Dar MR, Masood M, Al Menhali ARS, Al Nuaimi MM, Sreedharan J, Gasmelseed HI, Khan AA. Methylprednisolone Treatment Versus Standard Supportive Care for Adult COVID-19 Mechanically Ventilated, Acute Respiratory Distress Syndrome Patients. SN Compr Clin Med 2022; 4:11. [PMID: 35005432 PMCID: PMC8721188 DOI: 10.1007/s42399-021-01084-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 01/08/2023]
Abstract
A myriad of symptoms presented by severely ill mechanically ventilated COVID-19 patients has added pressure on the caregivers to explore therapeutic options. Systemic steroids have been reported to therapeutically benefit patients, with elevated inflammatory markers, during the severe acute respiratory syndrome, and the Middle East respiratory syndrome outbreak. COVID-19 disease is characterized by inflammation of the respiratory system and acute respiratory distress syndrome. Given the lack of specific treatment for COVID-19, the current study aimed to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment for mechanically ventilated hospitalized COVID-19 patients with severe COVID pneumonia. Data were collected retrospectively from the electronic patient medical records, and interrater reliability was determined to limit selection bias. Descriptive and inferential statistical methods were used to analyze the data. The variables were cross-tabulated with the clinical outcome, and the chi-square test was used to determine the association between the outcomes and other independent variables. Sixty-one percent (43/70) of the COVID-19 ARDS patients received standard supportive care, and the remainder were administered, methylprednisolone (minimum 40 mg daily to a maximum 40 mg q 6 h). A 28-day all-cause mortality rate, in the methylprednisolone group, was 18% (5/27, p < 0.01) significantly lower, compared to the group receiving standard supportive care (51%, 22/43). The median number of days, for the hospital length of stay (18 days), ICU length of stay (9.5 days), and the number of days intubated (6 days) for the methylprednisolone-treated group, was significantly lower (p < 0.01) when compared with the standard supportive care group. Methylprednisolone treatment also reduced the C-reactive protein levels, compared to the standard care group on day 7. Our results strengthen the evidence for the role of steroids in reducing mortality, ICU length of stay, and ventilator days in mechanically ventilated COVID-19 patients with respiratory distress syndrome.
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Affiliation(s)
- Masood Ur Rahman
- Department of Critical Care Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Satish Chandrasekhar Nair
- Department of Academic Affairs, Tawam Hospital, College of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Mehraj Ud Din
- Department of Critical Care Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Mohammed Reidwan Dar
- Department of Critical Care Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Murriam Masood
- Department of Academic Affairs, Internal Medicine Residency Program, Tawam Hospital, Al Ain, United Arab Emirates
| | - Al Reem Salem Al Menhali
- Department of Academic Affairs, Internal Medicine Residency Program, Tawam Hospital, Al Ain, United Arab Emirates
| | - Mouza Mohammed Al Nuaimi
- Department of Academic Affairs, Internal Medicine Residency Program, Tawam Hospital, Al Ain, United Arab Emirates
| | - Jayadevan Sreedharan
- Department of Community Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Huda Imam Gasmelseed
- Department of Community Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Asad Afroz Khan
- Department of Infectious Diseases, Tawam Hospital, Al Ain, United Arab Emirates
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12
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Fowler SW, Price ARG. Contaminant enrichment and toxicity of the Gulf's sea surface microlayer: Baseline for determining long-term persistence. Mar Pollut Bull 2022; 174:113267. [PMID: 35090266 DOI: 10.1016/j.marpolbul.2021.113267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
The Gulf contains important biodiversity, but is also heavily impacted. While studies have measured seawater contaminants and toxicity, we are not aware of discrete sampling of the sea surface microlayer (SML). This ocean-atmosphere interface is important environmentally, but also sensitive to marine and atmospheric contaminant inputs. We sampled the SML and subsurface seawater (SSW) from the Gulf in August 1991 and 1992. The SML exhibited significant enrichment of petroleum hydrocarbons, Cu, Cd and Pb, which persisted more than one year after the massive 1991 Gulf War oil spill. Toxicity to echinoderm larvae was also greater in the SML. This likely reflects effects of contaminants measured and other stressors. Sophisticated techniques used over recent decades to determine biological effects of contaminants in the Gulf could usefully extend to the SML. Our study has demonstrated its sensitivity and could serve as a 'baseline' for determining long-term persistence of seawater contamination and toxicity.
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Affiliation(s)
- Scott W Fowler
- School of Marine and Atmospheric Sciences, Stony Brook University, Stony Brook, NY 11794-5000, USA
| | - Andrew R G Price
- School of Life Sciences, University of Warwick, Coventry CV4 7AL, UK.
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13
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Nair SC, Gasmelseed HI, Khan AA, Khafagy IN, Sreedharan J, Saleem AA, Abdrhman HI, Alhosani AH, Siddiqua AR, Ahmed AR, Shubbar AI, Aleissaee AR, Alanqar AW, Hamadeh AM, Safdani FA, Habbal FW, Choker HB, Bashir KM, Alblooshi MA, Farajallah MM, Alzaabi MN, Shil RS, Alshehhi SS, Douleh WF. Assessment of mortality from COVID-19 in a multicultural multi-ethnic patient population. BMC Infect Dis 2021; 21:1115. [PMID: 34715808 PMCID: PMC8554744 DOI: 10.1186/s12879-021-06762-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/28/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Studies indicate that ethnicity and socioeconomic disparity are significant facilitators for COVID-19 mortality. The United Arab Emirates, distinctly has a population of almost 12% citizens and the rest, immigrants, are mainly unskilled labourers. The disparate socio-economic structure, crowded housing conditions, and multi-ethnic population offer a unique set of challenges in COVID-19 management. METHODS Patient characteristics, comorbidities, and clinical outcomes data from the electronic patient medical records were retrospectively extracted from the hospital information system of the two designated public COVID-19 referral hospitals. Chi-square test, logistic regression, and odds ratio were used to analyse the variables. RESULTS From, the total of 3072 patients, less than one-fifth were females; the Asian population (71.2%);followed by Middle Eastern Arabs (23.3%) were the most infected by the virus. Diabetes Mellitus (26.8%), hypertension (25.7%) and heart disease (9.6%) were the most prevalent comorbidities observed among COVID-19 patients. Kidney disease as comorbidity significantly diminished the survival rates (Crude OR 9.6, 95% CI (5.6-16.6), p < 0.001) and (Adjusted OR 5.7 95% CI (3.0 - 10.8), p < 0.001), as compared to those patients without kidney disease. Similarly, the higher age of patients between 51 and 65 years, significantly decreased the odds for survival (Crude OR 14.1 95% CI (3.4-58.4), p < 0.001) and (Adjusted OR 12.3 95% CI (2.9 - 52.4), p < 0.001). Patient age beyond 66 years, further significantly decreased the odds for survival (Crude OR 36.1 95% CI (8.5-154.1), p < 0.001), and (Adjusted OR 26.6 95% CI (5.7 - 123.8), p < 0.001). CONCLUSION Our study indicates that older ages above 51 years and kidney disease increased mortality significantly in COVID-19 patients. Ethnicity was not significantly associated with mortality in the UAE population. Our findings are important in the management of the COVID-19 disease in the region with similar economic, social, cultural, and ethnic backgrounds.
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Affiliation(s)
- Satish Chandrasekhar Nair
- Department of Academic Affairs, College of Medicine & Health Sciences, Tawam Hospital, UAE University, Academic Affairs, Post Box 15258, Al Ain, UAE.
| | - Huda Imam Gasmelseed
- Department of Infectious Diseases, Internal Medicine, Al Ain Hospital, Al Ain, UAE
| | - Asad Afroz Khan
- Department of Infectious Diseases, Internal Medicine, Tawam Hospital, Al Ain, UAE
| | | | | | - Aqeel Aziz Saleem
- Department of Infectious Diseases, Internal Medicine, Tawam Hospital, Al Ain, UAE
| | | | | | | | - Amna Riaz Ahmed
- Department of Academic Affairs, Internal Medicine, Tawam Hospital, Al Ain, UAE
| | - Aya Imad Shubbar
- Department of Academic Affairs, Internal Medicine, Tawam Hospital, Al Ain, UAE
| | | | | | | | - Fatmah Ali Safdani
- Department of Academic Affairs, Internal Medicine, Tawam Hospital, Al Ain, UAE
| | - Fuad Wardan Habbal
- Department of Academic Affairs, Internal Medicine, Tawam Hospital, Al Ain, UAE
| | | | | | | | | | | | - Rajish Sanjit Shil
- Department of Academic Affairs, Internal Medicine, Tawam Hospital, Al Ain, UAE
| | - Saif Saeed Alshehhi
- Department of Academic Affairs, Internal Medicine, Tawam Hospital, Al Ain, UAE
| | - Wafa Fayez Douleh
- Department of Infectious Disease, Internal Medicine, Al Ain Hospital, Al Ain, UAE
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14
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Mahajan M, Manek D, Vora N, Kothari RK, Mootapally C, Nathani NM. Fungi with high ability to crunch multiple Polycyclic Aromatic Hydrocarbons (PAHs) from the pelagic sediments of Gulfs of Gujarat. Mar Pollut Bull 2021; 167:112293. [PMID: 33799152 DOI: 10.1016/j.marpolbul.2021.112293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
Marine ecosystem harbors diverse microbial diversity adapted to varied environmental conditions and stress. Gujarat possesses a wide coastline with unique and diverse niche in its two Gulfs. PAHs enter marine environments through various anthropogenic discharges and act as a threat to environment due to their xenobiotic nature. In the present study, sediment cores were collected across 4 coordinates, each from Gulf of Kutch and Khambhat; while one from Arabian sea. These samples were enriched for fungal growth in basal medium supplemented with naphthalene, pyrene, phenanthrene, anthracene and fluoranthene. Eight isolates were obtained from 3 samples and checked for tolerance against 5 PAHs followed by assessment of their biodegradation ability. Penicillium ilerdanum NPDF1239-K3-F21 and Aspergillus versicolor NPDF190-C1-26 showed >75% ability to degrade multiple PAHs. The results reveal the potential of fungal isolates from pelagic sediment for further in situ optimization and application in PAH removal from contaminated soil and sediment.
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Affiliation(s)
- Mayur Mahajan
- AIC - GISC Foundation, Gujarat Technological University, Ahmedabad 382424, Gujarat, India
| | - Devika Manek
- Institute of Biotechnology, Saurashtra University, Rajkot 360005, Gujarat, India
| | - Nishant Vora
- Institute of Biotechnology, Saurashtra University, Rajkot 360005, Gujarat, India
| | - Ramesh K Kothari
- Institute of Biotechnology, Saurashtra University, Rajkot 360005, Gujarat, India
| | | | - Neelam M Nathani
- Institute of Biotechnology, Saurashtra University, Rajkot 360005, Gujarat, India.
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15
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Kiernan KL, Al Fahim M, Harhara T, Nair SC, Ibrahim H. Intelligent Graduate Medical Education Dashboard (IGMED) to Enhance Trainee Oversight During the COVID-19 Pandemic. Acta Inform Med 2021; 29:10-14. [PMID: 34012207 PMCID: PMC8116082 DOI: 10.5455/aim.2021.29.10-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Medical residents comprise a large, but unique, subset of the physician workforce. They serve as front-line staff, but are trainees, regulated by duty hour and supervision restrictions. Heightened oversight is necessary to ensure resident supervision and safety whilst mobilizing this important workforce during crisis. This manuscript describes the development and implementation of an institutional crisis dashboard to facilitate timely information gathering and decision-making regarding resident activities during the COVID-19 pandemic. Objective: The purpose of the study was to develop an intelligent graduate medical education dashboard to centralize and integrate data to support accurate, timely decisions in several areas: (1) track redeployment; (2) ensure adherence to supervision and duty hour regulations; and (3) monitor infection control and safety measures. Methods: The dashboard is a live Microsoft Excel database saved to a shared fileserver. All existing databases within the education department were reviewed to form a foundational template. A monitoring section provides at-a-glance information on trainee assignments. Embedded color-coded flags attached to specific responses immediately highlight areas of deficiency. Results: The dashboard facilitated the efficient mobilization of trainees, while ensuring assignments followed education regulations. It allowed the education office to centralize and proactively arrange mass scrubs orders, facemask fitting, and personal protective equipment training. It was a monitoring system that enabled recognition of safety concerns in real-time, including identifying areas where residents were most exposed or infected. Conclusion: The dashboard improved the efficiency of crisis response, while prioritizing resident safety. It is feasible, low cost and easily accessible, even during Internet disruption. It can be used by hospitals worldwide, including low resource settings.
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Affiliation(s)
- Kellie L Kiernan
- Education Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Maha Al Fahim
- Education Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Thana Harhara
- Department of Family Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Satish Chandrasekhar Nair
- Tawam Hospital, Department of Academic Affairs, College of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Halah Ibrahim
- Department of Family Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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16
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Al Saffer Q, Al-Ghaith T, Alshehri A, Al-Mohammed R, Al Homidi S, Hamza MM, Herbst CH, Alazemi N. The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources. BMC Health Serv Res 2021; 21:365. [PMID: 33879136 PMCID: PMC8056511 DOI: 10.1186/s12913-021-06355-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary healthcare (PHC) is an essential component of an effective healthcare system. The Kingdom of Saudi Arabia's (KSA) health reforms prioritize tackling the increasing noncommunicable disease burden by prioritizing PHC, centering it as the core of the newly proposed Model of Care. To identify challenges and opportunities to scale up PHC capacity, understanding the current capacity of primary health care centers (PHCC) is critical. A limited number of publications review PHC capacity in KSA, focusing on specific regions/sectors; this paper is a first to examine PHC capacity on a national level. METHODS The study uses a countrywide Facility Survey that collected data in 2018 from 2319 PHCCs, generating information on their characteristics, number of health workers, services provided, and capacity elements captured through the Service Availability and Drug Availability constructed indices. Descriptive analysis was performed by rural-urban classification. Ordinary Least Squares (OLS) regressions were used to understand correlates to health workers and equipment availability. Finally, a logistic regression was fitted for selected services. Regressions controlled for various measures to determine correlates with facilities' capacity. RESULTS On a national level, there are 0.74 PHCCs per 10,000 population in KSA. There are variations in the distribution of PHCCs across regions and within regions across rural and urban areas. PHCCs in urban areas have more examination rooms but lower examination room densities. Offering 24 × 7 services in PHCCs is infrequent and dependency on paper-based medical recording remains common. More urban regions are more likely to offer general services but less likely to offer burn management and emergency services. PHCCs are mostly staffed with general medicine, family medicine, and obstetrics & gynecology physicians, whose numbers are more concentrated in urban areas; however, their densities are higher in rural areas. Finally, psychiatrists and nutritionists are rare to find in PHCCs. CONCLUSIONS Decision-makers need to consider several factors when designing PHC policies. For instance, PHC accreditation needs to be prioritized given its positive correlation with service provision and health workers availability. PHC 24 × 7 operation also needs considerations in rural areas due to the high dependency on PHCCs. Finally, there is a substantial need for improvements in e-health.
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17
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Sulaiman N, Rishmawy Y, Hussein A, Saber-Ayad M, Alzubaidi H, Al Kawas S, Hasan H, Guraya SY. A mixed methods approach to determine the climate of interprofessional education among medical and health sciences students. BMC Med Educ 2021; 21:203. [PMID: 33836727 PMCID: PMC8035734 DOI: 10.1186/s12909-021-02645-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/24/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND High-quality patient care is a complex phenomenon that requires collaboration among healthcare professionals. Research has shown that Interprofessional Education (IPE) carries promise to improve collaborative work and patient care. So far, collaboration among various health professionals remains a challenge. Very few focus group discussions to determine the medical students' readiness and positive attitudes towards IPE have been reported from the Arabian context. METHODS A two-staged sequential mixed methods study was conducted among medical, dental, pharmacy, and health sciences students of the University of Sharjah United Arab Emirates. The perspectives of students toward IPE and collaborative practice were first gathered by administering a validated instrument, Readiness for Interprofessional Learning Scale (RIPLS). This was followed by focused group discussions. A quantitative as well as a qualitative data analysis was performed. RESULTS This study cohort included 282 students. All respondents showed readiness to adopt IPE as all statements of the RIPLS inventory scored high median scores. All participants showed positive attitudes and readiness towards IPE. Three main domains of themes were generated from focus group discussions; prior knowledge, need for IPE framework and its implementation. Information workload, lack of clarity and less focused teaching pedagogies of IPE were considered as perceived barriers. CONCLUSION This study demonstrated a substantial agreement of medical and health sciences students towards readiness and perceived effectiveness of IPE. Educators are urged to embed new IPE programs into existing curricular frameworks, which can potentially enhance collaborative learning and improve quality of patient care.
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Affiliation(s)
- Nabil Sulaiman
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Department of Family & Community Medicine & Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Baker Heart and Diabetes Institute, Melbourne, Victoria Australia
| | - Youssef Rishmawy
- Department of Family & Community Medicine & Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Amal Hussein
- Department of Family & Community Medicine & Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Maha Saber-Ayad
- Department of Clinical Sciences, College of Medicine & Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- College of Medicine, Cairo University, Giza, Egypt
| | - Hamzah Alzubaidi
- Pharmacy Practice & Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Sausan Al Kawas
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hayder Hasan
- Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Salman Y. Guraya
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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18
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Azhar RA, Aldousari S, Alghamdi MM, Alotaibi MF, Alkhateeb SS, Nassir AM, Alshaalan A, Yaiesh S, Rabah D. Robot-Assisted Radical Prostatectomy in Low-Volume Regions: Should It Be Abandoned or Adopted? A Multi-Institutional Outcome Study. J Endourol 2021; 35:1013-1019. [PMID: 33470156 DOI: 10.1089/end.2020.0770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To present multinational experience in robot-assisted radical prostatectomy (RARP) by fellowship-trained expertise in low-volume regions in Gulf Cooperation Council (GCC) countries and to compare the current results with global outcomes reported in recent meta-analyses. Methods: A retrospective review of prospectively collected data was performed for patients undergoing RARP for localized prostate cancer (PCa). Three fellowship-trained surgeons at four academic and referral centers in Saudi Arabia and Kuwait performed all procedures between February 2014 and December 2019. Data on demographics, perioperative characteristics, pathology, and adverse events were collected. Results: A total of 207 patients were included with a median (IQR) follow-up duration of 28 (15-38) months. The median prostate volume and prostate-specific antigen were 42 (32-53) g and 9.1 (5.8-14.1) ng/mL, respectively. While 65.2% of patients had a Gleason score ≥7, 20% had grade group 4 disease, and 7.8% had ≥cT3 disease. The mean ± SD operative time was 203 ± 52 minutes, and the mean estimated blood loss was 158 ± 107 mL. Only 4 (1.9%) patients received perioperative blood transfusions. Positive surgical margins were observed in 21.7% of patients, all of whom had ≥pT3 disease. There were 23 complications in 18 (8.7%) patients, including Clavien-Dindo grade III complications in 2.4%. At the 12-month follow-up, 35.8% of patients were potent, 94.6% were continent, and 9.2% had biochemical recurrence. Conclusions: The safety and efficacy of RARP by fellowship-trained expertise in GCC countries were well established. The outcomes seem promising and comparable to international centers and should improve with increasing case volume and fellowship-trained expertise.
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Affiliation(s)
- Raed A Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saad Aldousari
- Department of Surgery, Division of Urology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.,Department of Urology, Division of Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Musab M Alghamdi
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed F Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Sultan S Alkhateeb
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Anmar M Nassir
- Department of Surgery, Umm-Alqura University, Makkah, Kingdom of Saudi Arabia
| | - Abdullah Alshaalan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Cancer Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Said Yaiesh
- Department of Surgery, Urology Unit, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Danny Rabah
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.,Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Cancer Research Chair, King Saud University, Riyadh, Saudi Arabia
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19
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Alosairi Y, Al-Salem SM, Al Ragum A. Three-dimensional numerical modelling of transport, fate and distribution of microplastics in the northwestern Arabian/Persian Gulf. Mar Pollut Bull 2020; 161:111723. [PMID: 33038712 DOI: 10.1016/j.marpolbul.2020.111723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
Marine plastic litter has been a major concern over the past decade particularly in semi-enclosed seas such as the Arabian/Persian Gulf, which are likely to impose a relatively higher threat to ecosystem and human health. In this work, we have focused our efforts on the transport features of marine surface microplastics (MPs) in the Gulf. The assessment utilizes a 3D hydrodynamic model of the northern Gulf which was coupled with a particle tracking model. We have considered five release locations and investigated two dominant wind conditions by applying different numerical scenarios. The results revealed that the northerly winds result in high dispersion and seaward transport of MPs in the open coastal zones, while in semi-enclosed regions they result in high trapping and beaching verified by visual investigation. The study shows that further detailed field investigations are warranted to enable the models to better parameterize the fate and distributions of MPs.
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Affiliation(s)
- Y Alosairi
- Environment & Life Sciences Research Centre, Kuwait Institute for Scientific Research (KISR), P.O. Box 24885, Safat 13109, Kuwait
| | - S M Al-Salem
- Environment & Life Sciences Research Centre, Kuwait Institute for Scientific Research (KISR), P.O. Box 24885, Safat 13109, Kuwait.
| | - A Al Ragum
- Environment & Life Sciences Research Centre, Kuwait Institute for Scientific Research (KISR), P.O. Box 24885, Safat 13109, Kuwait
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20
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Alsaedi RH. An Assessment of the Motor Performance Skills of Children with Autism Spectrum Disorder in the Gulf Region. Brain Sci 2020; 10:brainsci10090607. [PMID: 32899306 PMCID: PMC7564795 DOI: 10.3390/brainsci10090607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 11/16/2022] Open
Abstract
This study aims to determine the prevalence, severity, and nature of the motor abnormalities seen in children with autism spectrum disorder (ASD) as well as to elucidate the associated developmental profiles. The short-form of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) was used to assess various aspects of the motor performance of 119 children with ASD and 30 typically developing children (age range: 6–12 years) from three Gulf states. The results revealed the high prevalence of motor abnormalities among the ASD group when compared with the normative data derived from the BOT-2 manual as well as with the data concerning the typically developing group. The results also indicated that the motor performance of the children with ASD fell within the below-average range according to the BOT-2 cut-off score. Further, the results suggested that the age variable may influence the overall motor performance of children with ASD, since the children’s motor abnormalities may decrease with maturation. The results concerning the specific motor dysfunction profiles seen in individuals with ASD could help practitioners, parents, and educators to better understand the nature of the motor deficits exhibited by children with ASD, which could assist with the design and implementation of treatment and rehabilitation programs for such children. Overall, motor performance represents an important aspect that should be considered during the clinical evaluation of ASD and that should not be ignored during early interventions.
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Affiliation(s)
- Rehab H. Alsaedi
- Faculty of Education, Queensland University of Technology (QUT), Brisbane 4059, Australia;
- Department of Special Education, Taibah University, Madinah 41477, Saudi Arabia
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21
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Alahmad B, Shakarchi AF, Khraishah H, Alseaidan M, Gasana J, Al-Hemoud A, Koutrakis P, Fox MA. Extreme temperatures and mortality in Kuwait: Who is vulnerable? Sci Total Environ 2020; 732:139289. [PMID: 32438154 DOI: 10.1016/j.scitotenv.2020.139289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Previous climate change temperature-related health studies have been performed mostly in western countries with relatively cooler temperatures than the Gulf region. Regions that are inherently hot, like Kuwait, are witnessing soaring temperatures unlike ever before. Meanwhile, Kuwait and other Gulf countries are unique in their demographic profiles due to the large number of non-national migrant workers. OBJECTIVE To examine the associations of hot and cold temperature extremes on the risk of mortality across gender, age groups and nationality in Kuwait. METHODS We investigated daily variations of all-cause non-accidental and cardiovascular mortality death counts and ambient temperatures from 2010 to 2016 in a time-series design using a negative binomial distribution. The temperature lag was modeled with distributed lag non-linear models. RESULTS A total of 33,472 all-cause non-accidental deaths happened during the study period. For the extreme hot temperatures and over the entire lag period, comparing the 99th percentile of temperature to the minimum mortality temperature, the risk of dying among males was 2.08 (95% CI: 1.23-3.52). Among non-Kuwaitis, males and working age group (15-64 year) had relative risks of death from extreme hot temperatures of 2.90 (1.42-5.93), and 2.59 (1.20-5.59), respectively. For extreme cold temperatures and over the entire lag period, comparing the 1st percentile of temperature to the minimum mortality temperature, the relative risk of death among Kuwaitis was 2.03 (1.05-3.93). Elderly Kuwaitis (65+ year) exposed to extreme cold temperatures had a relative risk of 2.75 (1.16-6.52). CONCLUSIONS Certain subpopulations in Kuwait are vulnerable to extreme temperatures with doubling to tripling risk of mortality. Nationality is an important effect modifier in temperature-related mortality studies in Kuwait and possibly the Gulf region. To the best of our knowledge, we are the first study to examine specific subpopulation vulnerabilities to temperature in this region. Our findings could carry a potential for broader insight into similar hyper-arid and hot regions.
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Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait.
| | - Ahmed F Shakarchi
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Haitham Khraishah
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammad Alseaidan
- Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait
| | - Janvier Gasana
- Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Ali Al-Hemoud
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Petros Koutrakis
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mary A Fox
- Department of Health Policy and Management and Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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22
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Alsaedi RH, Carrington S, Watters JJ. Behavioral and Neuropsychological Evaluation of Executive Functions in Children with Autism Spectrum Disorder in the Gulf Region. Brain Sci 2020; 10:E120. [PMID: 32098341 DOI: 10.3390/brainsci10020120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 11/21/2022] Open
Abstract
This study examined the executive functioning abilities and development profiles of children with autism spectrum disorder (ASD). The participants were 119 children with ASD and 30 typically developing children (age range: 6–12 years) who were recruited from three Gulf states. The findings revealed executive functioning deficits in the ASD population when compared to the normative data or to those children without ASD. However, not all the forms of executive functioning were found to be impaired. Age-related differences in the patterns of performance on the utilized measures of executive functioning were also identified. The overall findings provide valuable information regarding the different components of the executive functions, which may prove useful in relation to the development of assessment protocols for ASD.
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Abstract
The leading chronic conditions in Arab Gulf States are modifiable by lifestyle change. Available evidence suggests a paucity of experimental studies on these conditions. We aimed to review the published randomized controlled trials on behavioral modification in the Arab Gulf States. Three databases (PubMed, Embase, and Cochrane) were searched for related keywords, and the records were screened for eligible studies; data were abstracted on trial characteristics (e.g. publication year, study population, primary outcome, intervention, control, follow-up, and outcome results), and a quality assessment of the trials was made. A total of 16 trials were eligible; 50% did not provide sample size calculation, and 31% did not designate a primary outcome. A majority of the trials did not explain randomization or allocation concealment (50%), did not blind outcome assessors (69%) or adopt an intention-to-treat analysis (56%); and 82% of trials found a significant intervention effect. More behavioral trials should be conducted overall and specifically for conditions for which there are no trials (e.g. respiratory tract infection and road injury).
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Affiliation(s)
- Nazmus Saquib
- College of Medicine, Sulaiman Al Rajhi Colleges, Al Bukairiyah, Kingdom of Saudi Arabia
| | - Ayman Yousif Ibrahim
- College of Medicine, Sulaiman Al Rajhi Colleges, Al Bukairiyah, Kingdom of Saudi Arabia
| | - Juliann Saquib
- College of Medicine, Qassim University, Buraydah, Kingdom of Saudi Arabia
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Saeed MO, Ershath MM, Al-Tisan IA. Perspective on desalination discharges and coastal environments of the Arabian Peninsula. Mar Environ Res 2019; 145:1-10. [PMID: 30771906 DOI: 10.1016/j.marenvres.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/29/2019] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
Two opposing views are held about the effects of desalination plants on coastal environments. One view is that brine discharged from desalination plants has minimal impact on the coastal environment. The other opinion claims that discharges from desalination plants pose a potential environmental hazard to coastal environments and particularly to those of the Arabian Gulf. The present study was carried out to determine whether negative environmental impacts could be detected in coastal waters of the Gulf and Red Sea near discharges from desalination plants in Saudi Arabia. Phytoplankton abundance, concentrations of chlorophyll a, nutrients, total suspended solids, trace metals, chlorination by-products, bacterial growth, and toxicity of effluents were assessed. Results indicate the brine discharges were not toxic to fish or brine shrimp. Mitigation of impacts from elevated temperature, salinity and chemicals in dual purpose plants is partly achieved by pre-dilution of brine reject stream with cooling water. Alternative pretreatment methods, chlorination and waste treatment are considered. There is accumulation of corrosion metals in sediments at the discharge site of a plant on the Gulf coast. However, their concentrations were within regulatory limits.
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Affiliation(s)
- Mohamed O Saeed
- Desalination Technologies Research Institute, Saline Water Conversion Corporation, PO BOX 8328, Al-Jubail, 31951, Saudi Arabia.
| | - Mi Mohamed Ershath
- Desalination Technologies Research Institute, Saline Water Conversion Corporation, PO BOX 8328, Al-Jubail, 31951, Saudi Arabia
| | - Ibrahim A Al-Tisan
- Desalination Technologies Research Institute, Saline Water Conversion Corporation, PO BOX 8328, Al-Jubail, 31951, Saudi Arabia
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25
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Nathani NM, Mootapally C, Dave BP. Antibiotic resistance genes allied to the pelagic sediment microbiome in the Gulf of Khambhat and Arabian Sea. Sci Total Environ 2019; 653:446-454. [PMID: 30412889 DOI: 10.1016/j.scitotenv.2018.10.409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 06/08/2023]
Abstract
Antibiotics have been widely spread in the environments, imposing profound stress on the resistome of the residing microbes. Marine microbiomes are well established large reservoirs of novel antibiotics and corresponding resistance genes. The Gulf of Khambhat is known for its extreme tides and complex sedimentation process. We performed high throughput sequencing and applied bioinformatics techniques on pelagic sediment microbiome across four coordinates of the Gulf of Khambhat to assess the marine resistome, its corresponding bacterial community and compared with the open Arabian Sea sample. We identified a total of 2354 unique types of resistance genes, with most abundant and diverse gene profile in the area that had anthropogenic activities being carried out on-shore. The genes with >1% abundance in all samples included carA, macB, sav1866, tlrC, srmB, taeA, tetA, oleC and bcrA which belonged to the macrolides, glycopeptides and peptide drug classes. ARG enriched phyla distribution was quite varying between all the sites, with Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes among the dominant phyla. Based on the outcomes, we also propose potential biomarker candidates Desulfovibrio, Thermotaga and Pelobacter for antibiotic monitoring in the two of the Gulf samples probable contamination prone environments, and genera Nitrosocccus, Marinobacter and Streptomyces in the rest of the three studied samples. Outcomes support the concept that ARGs naturally originate in environments and human activities contribute to the dissemination of antibiotic resistance.
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Affiliation(s)
- Neelam M Nathani
- Department of Life Sciences, Maharaja Krishnakumarsinhji Bhavnagar University, Bhavnagar 364-001, Gujarat, India.
| | - Chandrashekar Mootapally
- Department of Marine Science, Maharaja Krishnakumarsinhji Bhavnagar University, Bhavnagar 364-001, Gujarat, India.
| | - Bharti P Dave
- Department of Life Sciences, Maharaja Krishnakumarsinhji Bhavnagar University, Bhavnagar 364-001, Gujarat, India; School of Science, Indrashil University, Rajpur, Kadi, Mehsana 382-715, Gujarat, India.
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26
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Abstract
This article examines global social policy formation in the area of skilled migration, with a focus on the Gulf Arab region. Across the globe, migration governance presents challenges to multiple levels of authority; its complexity crosses many scales and involves a multitude of actors with diverse interests. Despite this jurisdictional complexity, migration remains one of the most staunchly defended realms of sovereign policy control. Building on global social policy literature, this article examines how 'domestic' labour migration policies reflect the entanglement of multiple states' and agencies' interests. Such entanglements result in what we characterize as a 'multiplex system', where skilled-migration policies are formed within, and shaped by, globalized policy spaces. To illustrate, we examine policies that shape the nursing labour market in Oman during a period when the state aims to transition from dependence on an expatriate to an increasingly nationalized labour force. Engaging a case-study methodology including a survey of migrant healthcare workers, semi-structured interviews and data analysis, we find that nursing labour markets in Oman represent an example of global policy formation due to the interaction of domestic and expatriate labour policies and provisioning systems. The transnational structuring of policy making that emerges reflects a contingent process marked by conflicting outcomes. We contend that Oman's nursing labour market is an example of new spaces where global social policies emerge from the tension of competing national state and market interests.
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Affiliation(s)
- Crystal A. Ennis
- Crystal A. Ennis, Leiden University, PO Box 9515, Leiden 2300 RA, The Netherlands.
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27
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Zowawi HM, Syrmis MW, Kidd TJ, Balkhy HH, Walsh TR, Al Johani SM, Al Jindan RY, Alfaresi M, Ibrahim E, Al-Jardani A, Al Salman J, Dashti AA, Sidjabat HE, Baz O, Trembizki E, Whiley DM, Paterson DL. Identification of carbapenem-resistant Pseudomonas aeruginosa in selected hospitals of the Gulf Cooperation Council States: dominance of high-risk clones in the region. J Med Microbiol 2018; 67:846-853. [PMID: 29664716 DOI: 10.1099/jmm.0.000730] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The molecular epidemiology and resistance mechanisms of carbapenem-resistant Pseudomonas aeruginosa (CRPA) were determined in hospitals in the countries of the Gulf Cooperation Council (GCC), namely, Saudi Arabia, the United Arab Emirates, Oman, Qatar, Bahrain and Kuwait. METHODOLOGY Isolates were screened for common carbapenem-resistance genes by PCR. Relatedness between isolates was assessed using previously described genotyping methods: an informative-single nucleotide polymorphism MassARRAY iPLEX assay (iPLEX20SNP) and the enterobacterial repetitive intergenic consensus (ERIC)-PCR assay, with selected isolates being subjected to multilocus sequence typing (MLST). Ninety-five non-repetitive isolates that were found to be resistant to carbapenems were subjected to further investigation.Results/Key findings. The most prevalent carbapenemase-encoding gene, blaVIM-type, was found in 37/95 (39 %) isolates, while only 1 isolate (from UAE) was found to have blaIMP-type. None of the CRPA were found to have blaNDM-type or blaKPC-type. We found a total of 14 sequence type (ST) clusters, with 4 of these clusters being observed in more than 1 country. Several clusters belonged to the previously recognized internationally disseminated high-risk clones ST357, ST235, ST111, ST233 and ST654. We also found the less predominant ST316, ST308 and ST823 clones, and novel MLST types (ST2010, ST2011, ST2012 and ST2013), in our collection. CONCLUSION Overall our data show that 'high-risk' CRPA clones are now detected in the region and highlight the need for strategies to limit further spread of such organisms, including enhanced surveillance, infection control precautions and further promotion of antibiotic stewardship programmes.
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Affiliation(s)
- Hosam M Zowawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.,WHO Collaborating Centre for Infection Prevention and Control, and GCC Center for Infection Control, Riyadh, Saudi Arabia
| | | | - Timothy J Kidd
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia.,Centre for Experimental Medicine, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Hanan H Balkhy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.,WHO Collaborating Centre for Infection Prevention and Control, and GCC Center for Infection Control, Riyadh, Saudi Arabia
| | - Timothy R Walsh
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.,Department of Medical Microbiology and Infectious Diseases, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Sameera M Al Johani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Microbiology, Department of Pathology and Lab Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Reem Y Al Jindan
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mubarak Alfaresi
- Pathology and Laboratory Medicine Department at Sheikh Khalifa General Hospital, Umm Al Quwain, UAE.,College of Medicine, University of Sharjah, UAE
| | - Emad Ibrahim
- Clinical Microbiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Amina Al-Jardani
- Medical Microbiology Department, The Royal Hospital, Muscat, Oman
| | - Jameela Al Salman
- Samlaniya Medical Complex, Infectious Diseases Unit, Manama, Bahrain
| | - Ali A Dashti
- Medical Laboratory Department, Faculty of Allied Health Sciences, Health Science Center, Kuwait University, Kuwait City, Kuwait
| | - Hanna E Sidjabat
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Omar Baz
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Ella Trembizki
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - David M Whiley
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.,Pathology Queensland, Brisbane, Queensland 4029, Australia
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
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28
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El Shiekh AR, Farrag HA, Ashour T, Alshali KZ, AbdelFattah W. Clinical safety of insulin detemir in patients with Type 2 diabetes in the Gulf countries: The multicenter, noninterventional, open-label LevSafe study. Indian J Endocrinol Metab 2016; 20:443-450. [PMID: 27366709 PMCID: PMC4911832 DOI: 10.4103/2230-8210.183461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIM To evaluate the safety profile of insulin detemir (IDet) in people with Type 2 diabetes mellitus (T2DM) in the Gulf countries in the 32-week, noninterventional LevSafe study. METHODS People with T2DM whose physicians had opted to start IDet therapy were included in the study. Safety parameters, including serious adverse drug reactions (SADRs) and hypoglycemia, and changes in body weight and glycemic control were evaluated at baseline, week 16 and week 32. RESULTS A total of 686 patients were exposed to IDet therapy with a mean (±standard deviation) age, body mass index, and diabetes duration of 51.3 ± 11.0 years, 31.3 ± 5.5 kg/m(2), and 10.2 ± 6.1 years, respectively. The mean total daily dose of IDet was 32.0 ± 32.8 U at baseline and 44.7 ± 60.7 U at week 32. No SADRs were reported during the study. Total hypoglycemia decreased from 435 events at baseline to 204 events at week 32 (mean change analyzed by Wilcoxon signed rank test: -0.34; P = 0.0115), and no major hypoglycemia was reported at week 32. Over the 32-week treatment period, the mean body weight decreased from 85.7 ± 15.2 kg to 85.4 ± 14.5 kg (P = 0.0203), glycated hemoglobin A1c from 9.9 ± 1.67% to 7.7 ± 1.36% (P < 0.0001), and fasting plasma glucose from 11.9 ± 3.27 mmol/L to 7.4 ± 1.85 mmol/L (P < 0.0001). CONCLUSION IDet therapy was well-tolerated and was associated with a decreased number of hypoglycemic events and improved glycemic control after 32 weeks in patients with T2DM in the Gulf countries.
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Affiliation(s)
- Abdel Rahman El Shiekh
- Department of Internal Medicine and Endocrinology, King Abdulaziz University, Jeddah, Chairman of Saudi Scientific Diabetes Society, Saudi Arabia
| | - Hesham A. Farrag
- Department of Internal Medicine, Saudi Airlines Medical Services, Jeddah, Saudi Arabia
| | - Tarek Ashour
- Department of Internal Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
| | | | - Waleed AbdelFattah
- Clinical, Medical, and Quality Department, Novo Nordisk Pharma Gulf, Riyadh, Saudi Arabia
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Sheppard C. Coral reefs in the Gulf are mostly dead now, but can we do anything about it? Mar Pollut Bull 2016; 105:593-598. [PMID: 26490413 DOI: 10.1016/j.marpolbul.2015.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/03/2015] [Accepted: 09/21/2015] [Indexed: 06/05/2023]
Abstract
This article discusses two key issues: firstly, the demise of reefs in the Gulf which is happening probably more rapidly than elsewhere; and secondly, the reasons why this remains such an intractable problem. Most reasons for this decline are scientifically well understood, though clearly not by the region's managers. Several factors may cause people to ignore the problem, even though habitat loss is vastly costly to the region. About 70% of the Gulf's reefs have essentially disappeared in a few decades, and although scientific indicators confirm that this is happening, it is commonly discounted as even being a possibility. Management of human interactions with the Gulf's marine systems remains very inadequate, to the detriment of the Gulf's marine systems and its people. It is clear that this not a scientific issue any longer but rather it is a political problem and failure.
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Affiliation(s)
- Charles Sheppard
- Department of Life Sciences, University of Warwick, CV4 7AL, UK.
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30
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Abstract
AIM To describe the status of diabetes control and complications, and the quality of diabetes management in Saudi Arabia, Kuwait, and the United Arab Emirates, and to obtain an insight into the relationship between these factors. METHODS Patients with diabetes for>12 months were enrolled from specialist clinics and general hospitals. All available data from the patients' medical files including patient demographics; glycemic, lipid, and blood pressure status; diabetes-related complications; and diabetes management were recorded in data collection forms and analyzed. RESULTS Overall, 1290 patients with diabetes were enrolled with a mean (±standard deviation) age of 49.4 ± 12.3 years and duration of diabetes of 8.7 ± 5.9 years. Glycemic control was poor: Mean glycated hemoglobin A1c of 8.3 ± 2.0%, fasting and postprandial plasma glucose levels of 155.9 ± 57.1 mg/dL (8.7 ± 3.2 mmol/L), and 218.2 ± 87.4 mg/dL (12.1 ± 4.9 mmol/L), respectively. Diabetes-related complications such as neuropathy (34.9% of patients), background retinopathy (29.9%), and cataract (14.1%) were common. Cardiovascular complications were reported in <10% of patients, and microalbuminuria was detected in 34.4% of patients. Oral antidiabetic drug (OAD) monotherapy (43.3%) was the most common treatment, followed by insulin + OADs (39.3%) and insulin monotherapy (17.6%). CONCLUSION The status of diabetes care was found to be suboptimal. Further improvements in diabetes management are necessary to prevent or delay the development of diabetes-related complications.
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Affiliation(s)
| | - Khaled Khudada
- Department of Internal Medicine, Ahmadi Hospital, Kuwait Oil Company, Al Ahmadi, Kuwait
| | - Saher Safarini
- Department of Endocrinology and Metabolic Diseases, Dallah Hospital, Riyadh, Saudi Arabia
| | | | - Jalal Nafach
- Department of Endocrinology, Dubai Diabetes Center, Dubai, United Arab Emirates
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Abstract
Salivary gland tumours (SGT) are relatively rare cancers characterised by striking morphological diversity and wide variation in the global distribution of SGT incidence. Given the proximity to the head and neck structures, management of SGT has been clinically difficult. To the best of our knowledge, there are no epidemiological studies on SGT from the United Arab Emirates (UAE) or the Gulf Cooperation Council Countries (GCC). Patient charts (N = 314) and associated pathological records were systematically reviewed between the years 1998–2014. Predominance of benign (74%) compared with malignant (26%) SGT was observed. Among the 83 malignant SGT identified, frequency was higher in males (61%) than in females (39%) and peak occurrence was in the fifth decade of life. Mucoepidermoid carcinoma was the most common type of tumour (35%) followed by adenoid cystic carcinoma (18.1%) and acinar cell carcinoma (10.8%). A similar pattern of tumour distribution was seen in patients from GCC, Asian, and Middle East countries. This is the first report to address the distribution of salivary gland tumours in a multiethnic, multicultural population of the Gulf. The results suggest that the development of an SGT registry will help clinicians and researchers to better understand, manage, and treat this rare disease.
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Affiliation(s)
- Yasir Al Sarraj
- Ajman University of Science and Technology, Department of Oral and Maxillofacial Surgery, Post Box 346, United Arab Emirates
| | - Satish Chandrasekhar Nair
- Tawam Hospital- Johns Hopkins Medicine International Affiliate, Department of Academic Affairs-Medical Research, Post Box 15258, Al Ain, United Arab Emirates
| | - Ammar Al Siraj
- Mawi Medical Centre, Post Box 55510, Dubai, United Arab Emirates
| | - Maher AlShayeb
- Ajman University of Science and Technology, Department of Oral and Maxillofacial Surgery, Post Box 346, United Arab Emirates
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Zubaid M, Thani KB, Rashed W, Alsheikh-Ali A, Alrawahi N, Ridha M, Akbar M, Alenezi F, Alhamdan R, Almahmeed W, Ouda H, Al-Mulla A, Baslaib F, Shehab A, Alnuaimi A, Amin H, Krumholz HM. Design and Rationale of Gulf locals with Acute Coronary Syndrome Events (Gulf Coast) Registry. Open Cardiovasc Med J 2014; 8:88-93. [PMID: 25328551 PMCID: PMC4197526 DOI: 10.2174/1874192401408010088] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 12/22/2022] Open
Abstract
Objectives: To describe the risk profile, management and one-year outcomes of patients hospitalized with acute coronary syndrome (ACS) in the Gulf region of the Middle East. Subjects and Methods: The Gulf locals with acute coronary syndrome events (Gulf COAST) registry is a prospective, multinational, longitudinal, observational, cohort-based registry of consecutive citizens, from the Gulf region of the Middle East, admitted from January 2012 to January 2013 to 29 hospitals with a diagnosis of ACS. Data entered online included patient demographics, cardiovascular risk profiles, past medical history, physical findings on admission, in-hospital diagnostic tests and therapeutic management, as well as one year outcomes. Results: 3188 patients were recruited. The mean age was 60.4 ± 12.6years (range: 22-112), 2104 (66%) were males and 1084 (34%) females. The discharge diagnosis was ST-segment elevation myocardial infarction (STEMI) in 741 (23.2%), new-onset left bundle branch block myocardial infarction (LBBBMI) in 30 (0.9%), non-ST-segment elevation myocardial infarction (NSTEMI) in 1486 (46.6%) and unstable angina in 931 (29.2%). At hospital presentation, 2105 (66%), 1779 (55.8%), 1703 (53.4%) and 740 (23.2%) had history of hypertension, dyslipidemia, diabetes mellitus and active smoking, respectively. Conclusion: Patients with ACS in our region are young with very high risk profile. The Gulf COAST registry is an example of successful regional collaboration and will provide information on contemporary management of ACS in the region.
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Affiliation(s)
- Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | | | - Wafa Rashed
- Department of Medicine, Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait
| | - Alawi Alsheikh-Ali
- Heart and Vascular Institute, Sheikh Khalifa Medical City, Abu Dhabi, UAE; and Tufts University School of Medicine, Boston, MA, USA
| | | | - Mustafa Ridha
- Department of Medicine, Al-Adan, Ministry of Health, Kuwait
| | - Mousa Akbar
- Department of Medicine, Al-Sabah, Ministry of Health, Kuwait
| | - Fahad Alenezi
- Department of Medicine, Al-Sabah, Ministry of Health, Kuwait
| | - Rashed Alhamdan
- Department of Medicine, Al-Jahra, Ministry of Health, Kuwait
| | - Wael Almahmeed
- Institute of Cardiac Science, Sheikh Khalifa Medical City
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