Acute Coronary Syndrome in Oman : Results from the Gulf Registry of Acute Coronary Events

Acute coronary syndrome (ACS) is the most common cause of cardiovascular mortality and morbidity in Western countries. International guidelines for diagnosis and treatment have been developed based on randomised clinical trials. However, data from international registries report a lack of association between guideline recommendations and actual clinical practice. Similarly, the Gulf Heart Association initiated a registry called Gulf Registry of Acute Coronary Events (Gulf RACE). This registry was developed to determine the characteristics and management of ACS in the Gulf countries including Oman. Here, we report on the results of the various Gulf RACE registry studies from Oman and compare our results with the main Gulf RACE data as well as other international registries

Simple and Efficient Transcutaneous Inductive Micro-System Device Based on ASK Modulation at 6.78 MHz ISM Band

This paper deals with designing a simple and efficient simultaneous inductive power and data transmission for transcutaneous Micro-system based on ASK modulation at 6,78 MHz industrial, scientific, and medical (ISM) band to avoid the tissue damage. The modified ASK modulator and inductive coupling link driven by efficient Class-E power amplifier with 94,5% efficiency and the coupling link of up to 78,29% of efficiency are introduced to transmit 500 Kbit/s of data with modulation index 12,5%, modulation rate 7,37%. The proposed design is simple, easy to implement and able to power the bio-implantable devices with DC V up to 5 V. The mathematical model is given and the system is designed and validated by professional OrCADPsPice 16,6 environment simulation using a standard AMS 0,35 μm MOS technology. In addition, for real-time simulation, the electronic workbench MULISIM 11 has been used to simulate the class-E power amplifier switching. This design is useful for cochlear implants, retinal implants and implantable micro-system stimulator

Load Frequency Control for Hydropower Plants using PID Controller

Many development republics began to get rid of conventional energy and towards to use renewable energy like hydropower system, solar cells and wind turbines as soon as possible. Load Frequency Control (LFC) problem is coming to be the main topics for mentioning schemes due to not corresponding between main power system inputs such as change load demand and change in speed turbine settings. This paper illustrates a selftuning control of hydropower system that suggested and confirmed under Automatic Generation Control (AGC) in power scheme. The suggested power system involves one single area. The suggested self-tuning control system is employed in performing the automatic generation control for load frequency control request and compared it with conventional control structure. The power system dynamic modeling has regularly built in several essential parameters which have a significant influence According to frequency limitation. The main problem with all controllers is an exaggerated reaction to minor errors, producing the system to oscillate. The output response results for hydropower system obviously proved the benefit of using maximum load demand by tuning PID controller. Whereas, tuning PID controller has got properly more rapid output response and minimal overshoot

Load Frequency Control for Hydropower Plants using PID Controller

Many development republics began to get rid of conventional energy and towards to use renewable energy like hydropower system, solar cells and wind turbines as soon as possible. Load Frequency Control (LFC) problem is coming to be the main topics for mentioning schemes due to not corresponding between main power system inputs such as change load demand and change in speed turbine settings. This paper illustrates a selftuning control of hydropower system that suggested and confirmed under Automatic Generation Control (AGC) in power scheme. The suggested power system involves one single area. The suggested self-tuning control system is employed in performing the automatic generation control for load frequency control request and compared it with conventional control structure. The power system dynamic modeling has regularly built in several essential parameters which have a significant influence According to frequency limitation. The main problem with all controllers is an exaggerated reaction to minor errors, producing the system to oscillate. The output response results for hydropower system obviously proved the benefit of using maximum load demand by tuning PID controller. Whereas, tuning PID controller has got properly more rapid output response and minimal overshoot

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

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

The “obesity paradox” in patients with atrial fibrillation:Insights from the Gulf SAFE registry

BACKGROUND: The prognostic impact of obesity on patients with atrial fibrillation (AF) remains under-evaluated and controversial. METHODS: Patients with AF from the Gulf Survey of Atrial Fibrillation Events (Gulf SAFE) registry were included, who were recruited from six countries in the Middle East Gulf region and followed for 12 months. A multivariable model was established to investigate the association of obesity with clinical outcomes, including stroke or systemic embolism (SE), bleeding, admission for heart failure (HF) or AF, all-cause mortality, and a composite outcome. Restricted cubic splines were depicted to illustrate the relationship between body mass index (BMI) and outcomes. Sensitivity analysis was also conducted. RESULTS: A total of 1,804 patients with AF and recorded BMI entered the final analysis (mean age 56.2 ± 16.1 years, 47.0% female); 559 (31.0%) were obese (BMI over 30 kg/m(2)). In multivariable analysis, obesity was associated with reduced risks of stroke/systematic embolism [adjusted odds ratio (aOR) 0.40, 95% confidence interval (CI), 0.18–0.89], bleeding [aOR 0.44, 95%CI, 0.26–0.74], HF admission (aOR 0.61, 95%CI, 0.41–0.90) and the composite outcome (aOR 0.65, 95%CI, 0.50–0.84). As a continuous variable, higher BMI was associated with lower risks for stroke/SE, bleeding, HF admission, all-cause mortality, and the composite outcome as demonstrated by the accumulated incidence of events and restricted cubic splines. This “protective effect” of obesity was more prominent in some subgroups of patients. CONCLUSION: Among patients with AF, obesity and higher BMI were associated with a more favorable prognosis in the Gulf SAFE registry. The underlying mechanisms for this obesity “paradox” merit further exploration

Development and Validation of R-hf Risk Score in Acute Heart Failure Patients in the Middle East

Objectives: The Rajan’s heart failure (R-hf) score was proposed to aid risk stratification in heart failure patients. The aim of this study was to validate R-hf risk score in patients with acute decompensated heart failure. Methods: R-hf risk score is derived from the product estimated glomerular filtration rate (mL/min), left ventricular ejection fraction (%), and hemoglobin levels (g/dL) divided by N-terminal pro-brain natriuretic peptide (pg/mL). This was a multinational, multicenter, prospective registry of heart failure from seven countries in the Middle East. Univariable and multivariable logistic regression was applied. Results: A total of 776 patients (mean age = 62.0±14.0 years, 62.4% males; mean left ventricular ejection fraction = 33.0±14.0%) were included. Of these, 459 (59.1%) presented with acute decompensated chronic heart failure. The R-hf risk score group (≤ 5) was marginally associated with a higher risk of all-cause cumulative mortality at three months (adjusted odds ratio (aOR) = 4.28; 95% CI: 0.90–20.30; p =0.067) and significantly at 12 months (aOR = 3.84; 95% CI: 1.23–12.00; p =0.021) when compared to those with the highest R score group (≥ 50). Conclusions: Lower R-hf risk scores are associated with increased risk of all-cause cumulative mortality at three and 12 months

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

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