169 research outputs found

    Human leukocyte antigen class II genetic variants are highly associated with rheumatic heart disease in Yemeni patients

    Get PDF
    BackgroundHuman leukocyte antigen (HLA) class II polymorphisms have been reported as a risk factor for rheumatic heart disease (RHD); however, the predisposing HLA genetic variants were different in various populations.The aim of the studyThe aim of the study was to investigate the association of RHD with HLA class II alleles in Yemeni patients.MethodsHLA-DRB1 and-DQB1 polymorphisms were genotyped by PCR-SSOP reverse dot blot hybridization in 100 RHD patients and 50 healthy subjects with normal echocardiography (control group).Materials and methodsSubjects: Yemeni RHD patients aged …14 and 45 years who attended the out-patient clinic at Al-Thawra Hospital for treatment were asked for participated in this study. One hundred RHD patients (57 females, 43 males) were freely participated (case group). Gender and age matched healthy subjects aged—18 and 47 years in the same geographical area of the patients were invited to participate in this study (control group). Fifty healthy individuals (28 females, 22 males) were freely participated. Venous blood, 3–4ml was collected from each participant after obtaining the signed consent form. Echocardiogram was done for each patient to confirm the clinical finding of RHD. The healthy subjects were also subjected to echocardiograms to exclude asymptomatic RHD cases.HLA class II genotyping Genomic DNA was extracted from peripheral blood leukocytes using PureLink Genomic DNA kit (invitrogen, USA). HLA class II DRB1 and DQB1 genotypes were carried out using sequence-specific oligonucleotide-probe polymerase chain reaction, Dynal RELI SSOP HLA-DRB1 and HLA-DRB1 kits, respectively (Invitrogen, USA).Statistical analysisFrequency of HLA-DRB1 and HLA-DQB1 alleles were compared between the patients and the controls using the chi-square test. The p value and odds ratio (OR) were calculated using SPSS software, version 12, with 95% confidence intervals and Fisher exact correction for small numbers.ResultsThe results showed that HLA-DRB1∗07 and HLA-DQB1∗0203 allele were risk factors for RHD (P=0.005, OR=4; P=0.02, OR=8.7, respectively). In contrast, the HLA-DRB1∗11, HLA-DQB1∗0305 and HLA-DQB1∗0602 alleles showed a protection against RHD (P=0.01, OR=0.32; P=0.03, OR=0.23; P=0.01, OR=0.24, respectively).ConclusionHLA class II genetic variants were a predisposition factor for developing RHD in Yemeni subjects. This study also replicated the association of HLA-DRB1∗07 with RHD and suggested that HLA-DQB1∗0203 allele as a risk factor for RHD

    Peripheral Arterial Disease in Patients Presenting with Acute Coronary Syndrome in Six Middle Eastern Countries

    Get PDF
    To describe prevalence and impact of peripheral arterial disease (PAD) in patients with acute coronary syndrome (ACS), data were collected over 5 months from 6 Middle Eastern countries. Patients were divided into 2 groups (with and without PAD). Out of 6705 consecutive ACS patients, PAD was reported in 177 patients. In comparison to non-PAD, PAD patients were older and more likely to have cardiovascular risk factors. They were more likely to have high Killip class, high GRACE risk score, and non-ST elevation ACS (NSTEACS) at presentation. Thrombolytics, antiplatelet use, and coronary intervention were comparable in both groups. When presented with ST-elevation myocardial infarction (STEMI), patients with PAD had worse outcomes, while in NSTEACS; PAD was associated with higher rate of heart failure in comparison to non-PAD patients. In diabetics, PAD was associated with 2-fold increase in mortality when compared to non-PAD (P = 0.028). After adjustment, PAD was associated with high mortality in STEMI (adjusted OR 2.6; 95% CI 1.23–5.65, P = 0.01). Prevalence of PAD in ACS in the Gulf region is low. Patients with PAD and ACS constitute a high risk group and require more attention. PAD in patients with STEMI is an independent predictor of in-hospital death

    Polyvascular Disease in Patients Presenting with Acute Coronary Syndrome: Its Predictors and Outcomes

    Get PDF
    We evaluated prevalence and clinical outcome of polyvascular disease (PolyVD) in patients presenting with acute coronary syndrome (ACS). Data for 7689 consecutive ACS patients were collected from the 2nd Gulf Registry of Acute Coronary Events between October 2008 and June 2009. Patients were divided into 2 groups (ACS with versus without PolyVD). All-cause mortality was assessed at 1 and 12 months. Patients with PolyVD were older and more likely to have cardiovascular risk factors. On presentation, those patients were more likely to have atypical angina, high resting heart rate, high Killip class, and GRACE risk scoring. They were less likely to receive evidence-based therapies. Diabetes mellitus, renal failure, and hypertension were independent predictors for presence of PolyVD. PolyVD was associated with worse in-hospital outcomes (except for major bleedings) and all-cause mortality even after adjusting for baseline covariates. Great efforts should be directed toward primary and secondary preventive measures

    Demystifying Smoker's Paradox: A Propensity Score-Weighted Analysis in Patients Hospitalized With Acute Heart Failure.

    Get PDF
    Background Smoker's paradox has been observed with several vascular disorders, yet there are limited data in patients with acute heart failure (HF). We examined the effects of smoking in patients with acute HF using data from a large multicenter registry. The objective was to determine if the design and analytic approach could explain the smoker's paradox in acute HF mortality. Methods and Results The data were sourced from the acute HF registry (Gulf CARE [Gulf Acute Heart Failure Registry]), a multicenter registry that recruited patients over 10 months admitted with a diagnosis of acute HF from 47 hospitals in 7 Middle Eastern countries. The association between smoking and mortality (in hospital) was examined using covariate adjustment, making use of mortality risk factors. A parallel analysis was performed using covariate balancing through propensity scores. Of 5005 patients hospitalized with acute HF, 1103 (22%) were current smokers. The in-hospital mortality rates were significantly lower in current smoker's before (odds ratio, 0.71; 95% CI, 0.52-0.96) and more so after (odds ratio, 0.47; 95% CI, 0.31-0.70) covariate adjustment. With the propensity score-derived covariate balance, the smoking effect became much less certain (odds ratio, 0.63; 95% CI, 0.36-1.11). Conclusions The current study illustrates the fact that the smoker's paradox is likely to be a result of residual confounding as covariate adjustment may not resolve this if there are many competing prognostic confounders. In this situation, propensity score methods for covariate balancing seem preferable. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01467973.Gulf CARE (Gulf Acute Heart Failure Registry) is an investigator- initiated study conducted under the auspices of the Gulf Heart Association and funded by Servier, Paris, France; and (for centers in Saudi Arabia), by the Saudi Heart Association (The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia [research group number: RG -1436- 013]). This does not alter our adherence to policies on sharing data and materials; and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The publication of this article was funded by the Qatar National Library

    Regular Khat (Catha edulis) chewing is associated with elevated diastolic blood pressure among adults in Butajira, Ethiopia: A comparative study

    Get PDF
    <p>Abstract</p> <p>Background</p> <p>Fresh leaves and buds of the Khat plant (<it>Catha edulis</it>) contain Cathinone, an amphetamine like alkaloid responsible for its pharmacological action. Chewing of Khat has been associated with a transient rise in blood pressure and heart rate in experimental studies. Few studies examined the effect of regular or frequent Khat chewing on blood pressure at the population level. This study was conducted to examine the association of regular Khat chewing with blood pressure among adults.</p> <p>Methods</p> <p>We compared systolic and diastolic blood pressure of adults 35-65 years of age who reported regular chewing of Khat during the preceding five years to those who never chewed Khat during the same period. Study participants were recruited from purposively selected urban and rural villages of Butajira District in Ethiopia. The comparative groups, chewers (334) and non-chewers (330), were identified from among the general population through a house-to-house visit using a screening questionnaire. They were frequency-matched for sex and age within a five-year range. Data were collected through structured interviews and physical measurements including blood pressure, weight and height.</p> <p>Results</p> <p>The prevalence of hypertension was significantly higher among Khat chewers (13.4%) than non-chewers (10.7%), odds ratio (OR) = 1.66 (95% confidence interval (CI) 1.05, 3.13). A considerably high proportion of chewers (29.9%) than non-chewers (20.6%) had sub-optimal diastolic blood pressure (> 80 mmHg). The mean (sd) diastolic blood pressure was significantly higher among Khat chewers [75.0 (11.6)] than non-chewers [72.9 (11.7)], P < 0.05. Similarly, Khat chewers had significantly higher mean (sd) heart rate [76.3 (11.5)] than non-chewers [73.9 (12.6)], P < 0.05. There was no significant difference in mean systolic blood pressure between the two groups.</p> <p>Conclusion</p> <p>Regular chewing of Khat is associated with elevated mean diastolic blood pressure, which is consistent with the peripheral vasoconstrictor effect of Cathinone. Regular Khat chewing may have sustained effects on the cardiovascular system that can contribute to elevated blood pressure at the population level.</p

    Olanzapine and pulmonary embolism, a rare association: a case report

    Get PDF
    Venous thromboembolism is a very common pathological process for which there are many well known (and less well-known) predisposing factors. Likewise, olanzapine is a commonly used anti-psychotic medication
    corecore