Epidemiology and outcomes of out-of-hospital cardiac arrest in Qatar : A nationwide observational study

This is a pre-copyedited, author-produced pdf of an article accepted for publication in International Journal of Cardiology following peer review. The version of record, 'Epidemiology and outcomes of out-of-hospital cardiac arrest in Qatar: A nationwide observational study', F. B. Irfan, et.a., International Journal of Cardiology, Vol 223, pp 1007-1013, November 2016, first published on line on August 24, 2016, is available on line via doi: http;//dx.doi.org/10.1016/j.ijcard.2016.08.299 © 2016 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Background Out-of-hospital cardiac arrest (OHCA) studies from the Middle East and Asian region are limited. This study describes the epidemiology, emergency health services, and outcomes of OHCA in Qatar. Methods This was a prospective nationwide population-based observational study on OHCA patients in Qatar according to Utstein style guidelines, from June 2012 to May 2013. Data was collected from various sources; the national emergency medical service, 4 emergency departments, and 8 public hospitals. Results The annual crude incidence of presumed cardiac OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence was 87.8 per 100,000 population. Of the 447 OHCA patients included in the final analysis, most were male (n = 360, 80.5%) with median age of 51 years (IQR = 39–66). Frequently observed nationalities were Qatari (n = 89, 19.9%), Indian (n = 74, 16.6%) and Nepalese (n = 52, 11.6%). Bystander cardiopulmonary resuscitation (CPR) was carried out in 92 (20.6%) OHCA patients. Survival rate was 8.1% (n = 36) and multivariable logistic regression indicated that initial shockable rhythm (OR 13.4, 95% CI 5.4–33.3, p = 0.001) was associated with higher odds of survival while male gender (OR 0.27, 95% CI 0.1–0.8, p = 0.01) and advanced cardiac life support (ACLS) (OR 0.15, 95% CI 0.04–0.5, p = 0.02) were associated with lower odds of survival. Conclusions Standardized incidence and survival rates were comparable to Western countries. Although expatriates comprise more than 80% of the population, Qataris contributed 20% of the total cardiac arrests observed. There are significant opportunities to improve outcomes, including community-based CPR and defibrillation training.Peer reviewe

The frequency of Pseudomonas aeruginosa bacteria with some pathogenic bacteria in burns injuries and study their resistance to antibiotics

90 swabs taken from burn wounds of patients admitted to and attending burn unit in Azadi teaching hospital in Kirkuk from the period (14/12/2014 to 19/3/2015). The age of patients ranged from 11 months to 77 years the burn wounds infected in both sexes of patients, but females more than male (40 females, 27 male). The variable degrees of burn was from first to third degree was observed in the 90 patients. Some of the samples (26.86%) from revealed a mixed bacterial infection and 73.13% were single bacterial infection. Different gram positive and gram negative bacterial were isolated in different percentages as staph. aureus was isolated from 12.79% of cultures, staph. epidermidis isolated in 9.30%. While gram negative bacteria was isolated as follows (pseudomonas aeruginosa in 32.55%, klebsiella pneumoniae and Enterobacter cloacae in 17.44% for each, E.coli in 8.13% and proteus mirabilis in 2.32%). P. aeruginosa was the highest percentage of the all gram positive and gram negative bacteria isolates has been obtained 28 isolation percentage 32.5% from all 86 isolates. P. aeruginosa was isolated from single and mixed isolation (gram negative and gram positive) bacteria (E. cloacae, E.coli, K. Pneumoniae, P. mirabilis, S. aureus, S.spidermidis). Regarding the sensitivity of the P. aeruginosa from the cultures to different antibiotics , Twelve antibacterial agents were used including (Cefotaxime , Imipenem , Gentamicin , Amoxicillin , Auqmentin , Ampicillin , Ceftriaxone , Ceftazidime , Carbencillin , Amikacin , Ciprofloxacin , Tetracyclin ). Out of these antibiotics Pseudomonas aeruginosa were more resistant about 100% to (Augmentin , Amoxicillin , Ampicillin( , 93% to the (Ceftriaxone , Cefotaxime , Carbenicillin , Imipenem Gentamicin, Tetracyclin ) , 89% Ciprofloxacin, while it found less than (64-57)% Amikacin and Ceftazidime respectively. When comparing multiple antibiotic resistance among bacteria isolated from the mixed and individual infections there was a difference in the results, where the proportion of resistant mixed infections for (12) antibiotic was rates of 27.7% while the resistance of individual infection ratio Pseudomonas aeruginosa (12) antibiotic at 23-52 %

Isolate the bacteria Pseudomonas aeruginosa from different clinical samples and study the effect of pyocyanin pigments of some pathogenic bacterial

Three hundred clinical sample were collected from patients admitted and comers to (Azadi Teaching, Kirkuk General, kidsGeneral) hospitals, 140 sample from females with percentage (46.6%) and 160 sample frommale (53.3%), and through it found that 24 samples with percentage (17.14%) represented positive for bacterial growth in females and 26 samples with(16.25%) represented positive bacterial growth of male cases. The ability of Pseudo. aeruginosa to produce pyocyanin on various media were show that 43 clinical isolates of Pseudo.aeruginosa (86%) produced pyocyanin on two media (Nutrient agar, Muller hinton agar) and 15 (30%) produced the pigment on Macconky agar and 24 isolates (48%) on blood agar. While the effect of pyocyanin pigment on the growth of different pathogenic bacterial isolates the results showed that a gram positive bacteria such as Staphylococcus aureus was more sensitive to the pyocyanin pigment than gram negative bacteria (E.coli, klebsiella pneumonia) when grown on Nutrient agar or Muller hinton agar

Analysis of the Chemical Components Found in The Volatile Oils of Thymus vulgaris and Lavandula angustifolia and Their Antiviral Properties: A Case Study of Russia

Herbal medicines are natural remedies derived from plants or plant extracts. They have been used for thousands of years in traditional medicine and are still widely used today as alternative treatments for various health conditions. In this study, the antiviral effects of the volatile oils of Thymus vulgaris and Lavandula angustifolia were examined separately after identifying the constituents of the volatile oils of these two plants. Two plants, Thymus vulgaris and Lavandula angustifolia, grown in the open air, were collected from the surrounding plains of Mirny and Ust-Ilimsk cities in Russia, respectively. Using a Clevenger apparatus, the oil was independently extracted from each plant by distillation with water. By using gas chromatography tandem mass spectrometry (GC-MS), the obtained volatile oil was examined. The antiviral effects of these two plants\u27 essential oils were then studied independently on herpes simplex virus (HSV-1). These viruses can quickly multiply on HeLa or HEp-2 cancer cells and produce effects that specifically cause cytopathic effect. In the essential oil of the Lavandula angustifolia, 24 compounds including thymol, carvacrol, p-Cymene and caryophyllene were identified. In the essential oil of Thymus vulgaris, 27 substances including terpenin-4-L, p-cymene, γ-terpinene and sabinene were identified. Also, the antiviral effects of the volatile oil of these two plants were investigated separately with a concentration of 10-4 on HeLa cells infected with HSV-1, and the result was negative

Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis

Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumonia (IP) caused by leflunomide (LEF) were reported, but many of them were considered as the victims of opportunistic infection currently. In this paper, efficacy and safety of low-dose LEF classified by body weight (BW) were studied. Methods: Fifty-nine RA patients were started to administrate LEF from July 2007 to July 2009. Among them, 25 patients were excluded because of the combination with tacrolimus, and medication modification within 3 months before LEF. Remaining 34 RA patients administered 20 to 50 mg/week of LEF were followed up for 1 year and enrolled in this study. Dose of LEF was classified by BW (50 mg/week for over 50 kg, 40 mg/week for 40 to 50 kg and 20 to 30 mg/week for under 40 kg). The average age and RA duration of enrolled patients were 55.5 years old and 10.2 years. Prednisolone (PSL), methotrexate (MTX) and etanercept were used in 23, 28 and 2 patients, respectively. In case of insufficient response or adverse effect, dosage change or discontinuance of LEF were considered. Failure was defined as dosages up of PSL and MTX, or dosages down or discontinuance of LEF. Last observation carried forward method was used for the evaluation of failed patients at 1 year. Results: At 1 year after LEF start, good/ moderate/ no response assessed by the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score, including a 28-joint count (DAS28)-C reactive protein (CRP) were showed in 14/ 10/ 10 patients, respectively. The dosage changes of LEF at 1 year were dosage up: 10, same dosage: 5, dosage down: 8 and discontinuance: 11 patients. The survival rate of patients in this study was 23.5% (24 patients failed) but actual LEF continuous rate was 67.6% (11 patients discontinued) at 1 year. The major reason of failure was liver dysfunction, and pneumocystis pneumonia was occurred in 1 patient resulted in full recovery. One patient died of sepsis caused by decubitus ulcer infection. DAS28-CRP score was decreased from 3.9 to 2.7 significantly. Although CRP was decreased from 1.50 to 0.93 mg/dl, it wasn't significant. Matrix metalloproteinase (MMP)-3 was decreased from 220.0 to 174.2 ng/ml significantly. Glutamate pyruvate transaminase (GPT) was increased from 19 to 35 U/l and number of leukocyte was decreased from 7832 to 6271 significantly. DAS28-CRP, CRP, and MMP-3 were improved significantly with MTX, although they weren't without MTX. Increase of GPT and leukopenia were seen significantly with MTX, although they weren't without MTX. Conclusions: It was reported that the risks of IP caused by LEF in Japanese RA patients were past IP history, loading dose administration and low BW. Addition of low-dose LEF is a potent safe alternative for the patients showing unsatisfactory response to current medicines, but need to pay attention for liver function and infection caused by leukopenia, especially with MTX. Disclosure statement: The authors have declared no conflicts of interes

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Recurrent post-partum coronary artery dissection

Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD) dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA) dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view

The impact of infertility diagnosis on embryo-endometrial dialogue

Initial stages of implantation involve bi-directional molecular crosstalk between the blastocyst and endometrium. This study investigated an association between infertility etiologies, specifically advanced maternal age (AMA) and endometriosis, on the embryo-endometrial molecular dialogue prior to implantation. Co-culture experiments were performed with endometrial epithelial cells (EEC) and cryopreserved day 5 blastocysts (n?=?41???Grade 3BB) donated from patients presenting with AMA or endometriosis, compared to fertile donor oocyte controls. Extracellular vesicles isolated from co-culture supernatant were analyzed for miRNA expression and revealed significant alterations correlating to AMA or endometriosis. Specifically, AMA resulted in 16 miRNAs with increased expression (P???0.05) and strong evidence for negative regulation toward 206 target genes. VEGFA, a known activator of cell adhesion, displayed decreased expression (P???0.05), validating negative regulation by 4 of these increased miRNAs: miR-126; 150; 29a; 29b (P???0.05). In endometriosis patients, a total of 10 significantly altered miRNAs displayed increased expression compared to controls (miR-7b; 9; 24; 34b; 106a; 191; 200b; 200c; 342-3p; 484) (P???0.05), targeting 1014 strong evidence-based genes. Three target genes of miR-106a (CDKN1A, E2F1 and RUNX1) were independently validated. Functional annotation analysis of miRNA-target genes revealed enriched pathways for both infertility etiologies, including disrupted cell cycle regulation and proliferation (P???0.05). These extracellular vesicle-bound secreted miRNAs are key transcriptional regulators in embryo-endometrial dialogue and may be prospective biomarkers of implantation success. One of the limitations of this study is that it was a stimulated, in vitro model and therefore may not accurately reflect the in-vivo environment

Factors affecting commencement and cessation of smoking behaviour in Malaysian adults

<p>Abstract</p> <p>Background</p> <p>Tobacco consumption peak in developed countries has passed, however, it is on the increase in many developing countries. Apart from cigarettes, consumption of local hand-rolled cigarettes such as <it>bidi </it>and <it>rokok daun </it>are prevalent in specific communities. Although factors associated with smoking initiation and cessation has been investigated elsewhere, the only available data for Malaysia is on prevalence. This study aims to investigate factors associated with smoking initiation and cessation which is imperative in designing intervention programs.</p> <p>Methods</p> <p>Data were collected from 11,697 adults by trained recording clerks on sociodemographic characteristics, practice of other risk habit and details of smoking such as type, duration and frequency. Smoking commencement and cessation were analyzed using the Kaplan-Meier estimates and log-rank tests. Univariate and multivariate Cox proportional hazard regression models were used to calculate the hazard rate ratios.</p> <p>Results</p> <p>Males had a much higher prevalence of the habit (61.7%) as compared to females (5.8%). Cessation was found to be most common among the Chinese and those regularly consuming alcoholic beverages. Kaplan-Meier plot shows that although males are more likely to start smoking, females are found to be less likely to stop. History of betel quid chewing and alcohol consumption significantly increase the likelihood of commencement (p < 0.0001), while cessation was least likely among Indians, current quid chewers and kretek users (p < 0.01).</p> <p>Conclusions</p> <p>Gender, ethnicity, history of quid chewing and alcohol consumption have been found to be important factors in smoking commencement; while ethnicity, betel quid chewing and type of tobacco smoked influences cessation.</p