-
Valsartan/Sacubitril for Treatment of Hfref: A Single Center's Paradigm
Kathleen Lisa Morris,
Edward Shmukler,
Ann Schmit,
Sunit Preet Chaudhry,
Mary Norine Walsh,
Ashwin Ravichandran
Issue:
Volume 6, Issue 4, July 2018
Pages:
52-55
Received:
15 April 2018
Accepted:
12 June 2018
Published:
6 July 2018
Abstract: PARADIGM-HF compared valsartan/sacubitril (ARNI) with enalapril in symptomatic patients with heart failure with reduced ejection fraction (HFrEF) (1). It was stopped early after the boundary for overwhelming benefit in favor of ARNI had been reached. Patients taking ARNI had decreased symptoms, risk of HF hospitalization and all-cause and cardiovascular mortality. We sought to describe our center’s initial year of experience with this novel agent. A retrospective chart review was completed of all patients in our advanced HF clinic who were prescribed ARNI between August 2015 and October 2016. Outcomes data were collected through August 2017. Consistent with the Food and Drug Administration (FDA) indication, patients treated had NYHA class II, III or IV HF symptoms with LVEF of 35% or less. The majority of those prescribed ARNI were able to initiate the medication. However, a significant proportion of patients (26.4%) had to discontinue ARNI due to a variety of reasons, most commonly symptomatic hypotension (31.0%) and insufficient insurance coverage (31.0%). Only 30.5% of patients successfully treated reached the maximum dose; in 85% of these patients, hypotension limited up titration of therapy. PARADIGM-HF demonstrated benefit of ARNI therapy over enalapril in patients with HFrEF and therapy was well tolerated. In our real world experience, hypotension and lack of insurance coverage limited utilization. Further experience with this therapy in a non-trial setting will inform optimal patient selection and titration strategies. Expanded insurance coverage will be crucial to allow for patient access.
Abstract: PARADIGM-HF compared valsartan/sacubitril (ARNI) with enalapril in symptomatic patients with heart failure with reduced ejection fraction (HFrEF) (1). It was stopped early after the boundary for overwhelming benefit in favor of ARNI had been reached. Patients taking ARNI had decreased symptoms, risk of HF hospitalization and all-cause and cardiovas...
Show More
-
Acute Chest Pain in a 70-Year-Old Woman at CNHU-HKM Cotonou: Morbid Association or Diagnostic Wandering
Philippe Mahouna Adjagba,
Murielle Hounkponou,
Arnaud Sonou,
Kouessi Anthelme Agbodandé,
Salimatou Assani Moutaïrou,
Rosaire Bognon,
Ikram Akinocho,
Yessoufou Tchabi,
Martin Dèdonougbo Houénassi
Issue:
Volume 6, Issue 4, July 2018
Pages:
56-60
Received:
4 June 2018
Accepted:
28 June 2018
Published:
21 July 2018
Abstract: Objectives: Challenging differential diagnosis. Background: Acute myopericarditis and ACS STEMI share the presenting triad of acute chest pain, ST segment changes, and elevated cardiac enzymes. Differentiating is not always straightforward. Case Report: We reported the clinical observation of a 70-year-old woman admitted into cardiology intensive care for acute chest pain with electrocardiographic abnormalities suggestive of acute coronary syndrome with ST elevation (ACS STEMI). Pharmacological myocardial revascularization was done. Secondary evolution in the absence of initial coronary angiography is compatible with a myopericarditis of favorable evolution under empiric antibiotherapy. Coronarography performed remotely reveals a significant stenosis of the proximal and middle circumflex. Percutaneous angioplasty was successfully performed. Conclusion: In patients with acute chest pain, ST segment changes and elevated cardiac enzymes, coronary angiography can be useful in differential diagnosis.
Abstract: Objectives: Challenging differential diagnosis. Background: Acute myopericarditis and ACS STEMI share the presenting triad of acute chest pain, ST segment changes, and elevated cardiac enzymes. Differentiating is not always straightforward. Case Report: We reported the clinical observation of a 70-year-old woman admitted into cardiology intensive c...
Show More
-
Causes, Clinical Features and Treatment of Rhabdomyolysis: A Retrospective Analysis
Zongchao Yu,
Bo Hu,
Baozhang Guang,
Taksui Wong,
Wenyu Gong,
Wenxue Liang,
Yunyi Li,
Wolfgang Pommer,
Berthold Hocher,
Yongpin Lu,
Chen Yun,
Shufei Zeng,
Fanna Liu,
Lianghong Yin
Issue:
Volume 6, Issue 4, July 2018
Pages:
61-65
Received:
8 May 2018
Accepted:
14 June 2018
Published:
24 July 2018
Abstract: Abstract: Background: RM is a condition of skeletal muscle breakdown which ranges from an asymptomatic illness with elevation in CK level to a life-threatening condition associated with extreme elevation in CK, electrolyte imbalance, AKI, and disseminated intravascular coagulation. In this study, the author analyzed the causes, clinical features, and treatments of RM. Methods: The study collected the records of 48 patients in the First Affiliated Hospital of Jinan University who were diagnosed RM from June 2012 to August 2016. By using SPSS to analyse the data, the study draw a clear chart about the distribution of patients’ age, etiologies and clinical symptoms respectively. The statistic analysis also reveals dramatically change on CK and other indicators after treatment. Results: A total of 48 patients were eligible for the study (mean age = 29.7 ± 12.3 years; 36 males and 12 females). Strenuous exercises and infections took the greatest percent amount the causes of RM. Muscular weakness and muscle aches were the two most common symptoms. Among the patients, 42 received intravenous (IV) fluid therapy, and none developed acute kidney injury (AKI). The other six patients accepted CRRT, five of whom had an alleviation of their symptoms. One patient was transferred to another hospital for further treatment since the primary disease was dermatomyositis and it was non-responsive to immunotherapy. Discussion and conclusions: RM is treatable if early diagnosis, comprehensive therapy, active prevention, and the timely elimination of complications are put into effect. Its main symptoms such as muscle aches, muscular weakness, and dark urine may not presented at the same time. In this study, Strenuous exercise is the most common cause of RM and IV fluid therapy is the cornerstone of RM treatment. CRRT should also be considered when life-threatening electrolyte abnormalities emerge as complications of AKI, or when the RM is non-responsive to initial therapy.
Abstract: Abstract: Background: RM is a condition of skeletal muscle breakdown which ranges from an asymptomatic illness with elevation in CK level to a life-threatening condition associated with extreme elevation in CK, electrolyte imbalance, AKI, and disseminated intravascular coagulation. In this study, the author analyzed the causes, clinical features, a...
Show More
-
Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate
Evangelia Chrysanthopoulou,
Irene Karampela,
Chrysi Diakaki,
Maria Theodorakopoulou,
Apostolos Armaganidis
Issue:
Volume 6, Issue 4, July 2018
Pages:
66-72
Received:
15 June 2018
Accepted:
9 July 2018
Published:
4 August 2018
Abstract: Neural tube defects are the second most common congenital anomaly. Among the known risk factors, low levels of folic acid rank first as responsible for the majority of cases recorded worldwide. In 1986, the mandatory folic acid food fortification in the U.S.A. led to dramatic reduction of disease incidence, while for many people it was considered as one of the most successful interventions in the history of public health promotion. Despite the satisfactory results from all countries that adopted similar policies, a significant number of countries, including the EU, preferred alternative ways to address it, considering the very limited safety data for such an intervention. Today, after 20 years of mandatory fortification from a sufficiently representative sample (1/3 of the planet), the necessity to apply this at global level should probably be reviewed, since until now no correlation with unfavourable impacts has been demonstrated. Objective of the present review was to assess the necessity of mandatory folic acid food fortification in the context of congenital neural tube defects (NTDs) prevention. Material – Method: an extensive search in the electronic database PubMed was performed. Animal or in vivo studies and articles were excluded, due to the inability to draw conclusions that is frequently observed, as well as the strong suspicion of failure to respond to clinical data. Furthermore, part of the studies was derived from searches to the References of the articles of the aforementioned database. Conclusions: the decision of mandatory folic acid food fortification should be determined by specific factors as: disease prevalence, rates of planned pregnancies, efficiency of existing measures to decrease significantly the overall disease’s incidence and the folate level in the general population.
Abstract: Neural tube defects are the second most common congenital anomaly. Among the known risk factors, low levels of folic acid rank first as responsible for the majority of cases recorded worldwide. In 1986, the mandatory folic acid food fortification in the U.S.A. led to dramatic reduction of disease incidence, while for many people it was considered a...
Show More
-
Obesity Among Male Employees at Saudi Aramco: Trends, Factors, and Johns Hopkins Aramco Healthcare Recommendations
Alexander Woodman,
Nizar Jaoua
Issue:
Volume 6, Issue 4, July 2018
Pages:
73-81
Received:
29 June 2018
Accepted:
13 July 2018
Published:
7 August 2018
Abstract: The purpose of this primary data analysis is to estimate the prevalence of obesity in a specific workplace in the Kingdom of Saudi Arabia (KSA). The information would then be used to predict the prevalence of obesity among the male workforce of Saudi Aramco, the largest oil company in the world. A total of N=1,000 male employees (883Saudis, 117non-Saudis), aged 19-65, participated. They were randomly selected from several male Saudi Aramco stations and were asked to take a survey. Chi-square test was used to measure the significance effect of some independent variables on the BMI status. The overall prevalence was estimated, with a confidence level of 95%, at 22.5±2.6% for obesity, 36.7±3% for overweight, and 1±0.6% for underweight. The figures highly depended on the region where they spent their childhood, their age, nationality, and amount of exercise performed per week. For instance, 27.4±4.2% of those who grew up in the Eastern Province were estimated to be obese (vs. 16.5±3.5% among those raised elsewhere in KSA), and 28.7±5% of those who rarely exercise (less than 1 hour per week) were considered obese (vs. 17.8±4.1% among those who work out for at least 3 hours per week). As a result, a logistic model, involving these factors, was used for future prediction. For example, non-Saudis would be about 2.3 times more likely to be obese, and those aged 30-39 would be about 1.9 times more likely to be obese compared to “under 30” and “50 or more” age groups and 1.7 times more likely to be so than those aged 40-49. In addition, the lowest and highest conditional probabilities of obesity relative to this model were determined (6.6% and 66.4%). As a result, the likeliest male employees to be obese; the non-Saudi ones, raised in the Easter Province, aged 30-39 and exercise very little (less than 1h/w), would actually have more than two chances in three to be obese. Based on relatively concerning figures about obesity in male employees of Saudi Aramco, this paper recommends workplace wellness program model to improve the health of employees and their productivity, by creating an atmosphere of health and care for their well-being.
Abstract: The purpose of this primary data analysis is to estimate the prevalence of obesity in a specific workplace in the Kingdom of Saudi Arabia (KSA). The information would then be used to predict the prevalence of obesity among the male workforce of Saudi Aramco, the largest oil company in the world. A total of N=1,000 male employees (883Saudis, 117non-...
Show More
-
Factors Predicting Treatment Outcome in Hospitalized Patients with Acute Exacerbation of COPD (AECOPD)
Abhay Uppe,
Padmaraj Ankale,
Arti Sharma,
Ria Shah,
Girija Nair
Issue:
Volume 6, Issue 4, July 2018
Pages:
82-85
Received:
28 June 2018
Accepted:
19 July 2018
Published:
14 August 2018
Abstract: Objective: The aim of our study was to study the COPD phenotypes, comorbidities and factors predicting treatment outcomes in patients with acute exacerbations of COPD admitted in hospital. Methodology: A retrospective study of fifty patients with acute exacerbation of COPD admitted in a tertiary care hospital during July 2015 to August 2016 was done. Results: It was observed that the mean duration of hospital stay was 8 ± 7 days with 44% of the patient discharged in less than 7 days (short stay) and 56% of patients in more than 7 days (long stay). The factors favouring longer stay in hospital include history of current smoking, hypoxia and CO2 retention while patients on active COPD treatment and cessation of smoking leads to shorter hospital stay. Conclusion: For patients with acute exacerbations of COPD requiring hospitalization, history of current smoking with hypoxia and CO2 retention are associated with longer stay in hospital while patients on active COPD treatment and cessation of smoking leads to shorter hospital stay.
Abstract: Objective: The aim of our study was to study the COPD phenotypes, comorbidities and factors predicting treatment outcomes in patients with acute exacerbations of COPD admitted in hospital. Methodology: A retrospective study of fifty patients with acute exacerbation of COPD admitted in a tertiary care hospital during July 2015 to August 2016 was don...
Show More
