Migraine exacerbation during Ramadan fasting

Fasting for approximately 1 month is an obligatory practice for Muslims during the month of Ramadan. We attempted to evaluate the effect of the Ramadan fasting on the frequency of migraine attacks among observant Muslim migraine sufferers using a cohort cross-over study. Thirty-two observant Muslim migraine sufferers filled a migraine diary during the Ramadan month and the following month (control). Two patients failed to complete the fast because of migraine suffering. During the Ramadan month, the patient expressed 9.4 ± 4.3 migraine days in average (range 3–20) when compared with 3.7 ± 2.1 migraine days in average (range 1–10) during the control month (p < 0.001). This phenomenon was associated with longer duration of migraine, lower frequency of migraine attacks, and migraine with aura. It seemed to be less pronounced in patients experiencing throbbing headaches and in married patients. Previous prophylactic therapy did not dampen this. Physicians treating Muslim migraine patients should discuss potential Ramadan month exacerbation with their patients and provide counseling regarding the prevention of dehydration and caffeine withdrawal. Pharmacological prophylactic treatment should be considered

Quality of life at the dead sea region: the lower the better? an observational study

<p>Abstract</p> <p>Background</p> <p>The Dead Sea region, the lowest in the world at 410 meters below sea level, is considered a potent climatotherapy center for the treatment of different chronic diseases.</p> <p>Objective</p> <p>To assess the prevalence of chronic diseases and the quality of life of residents of the Dead Sea region compared with residents of the Ramat Negev region, which has a similar climate, but is situated 600 meters above sea level.</p> <p>Methods</p> <p>An observational study based on a self-administered questionnaire. Data were collected from kibbutz (communal settlement) members in both regions. Residents of the Dead Sea were the study group and of Ramat Negev were the control group. We compared demographic characteristics, the prevalence of different chronic diseases and health-related quality of life (HRQOL) using the SF-36 questionnaire.</p> <p>Results</p> <p>There was a higher prevalence of skin nevi and non-inflammatory rheumatic diseases (NIRD) among Dead Sea residents, but they had significantly higher HRQOL mean scores in general health (68.7 ± 21 vs. 64.4 ± 22, p = 0.023) and vitality (64.7 ± 17.9 vs. 59.6 ± 17.3, p = 0.001), as well as significantly higher summary scores: physical component score (80.7 ± 18.2 vs. 78 ± 18.6, p = 0.042), and mental component score (79 ± 16.4 vs. 77.2 ± 15, p = 0.02). These results did not change after adjusting for social-demographic characteristics, health-related habits, and chronic diseases.</p> <p>Conclusions</p> <p>No significant difference between the groups was found in the prevalence of most chronic diseases, except for higher rates of skin nevi and NIRD among Dead Sea residents. HRQOL was significantly higher among Dead Sea residents, both healthy or with chronic disease.</p

Changes over Time in Hemoglobin A1C (HbA1C) Levels Predict Long-Term Survival Following Acute Myocardial Infarction among Patients with Diabetes Mellitus

Frequent fluctuations of hemoglobin A1c (HbA1C) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA1C were calculated in each patient. The time intervals of ∆HbA1C values were classified as rapid (&lt;one year) and slow (≥one year) changes. The outcome was all-cause mortality. The highest mortality rates of 53.8% and 35.5% were found in the HbA1C &lt; 5.5–7% and ∆HbA1C = −2.5–(−2%) categories. A U-shaped association was observed between HbA1C and mortality: adjOR = 1.887 and adjOR = 1.302 for HbA1C &lt; 5.5% and ≥8.0%, respectively, as compared with 5.5–6.5% (p &lt; 0.001). Additionally, ∆HbA1C was associated with the outcome (U-shaped): adjOR = 2.376 and adjOR = 1.340 for the groups of &lt;−2.5% and ≥2.5% ∆HbA1C, respectively, as compared to minimal ∆HbA1C (±0.5%) (p &lt; 0.001). A rapid increase in HbA1C (but not decrease) was associated with a greater risk of mortality. HbA1C values and their changes are significant prognostic markers for long-term mortality among AMI-DM patients. ∆HbA1C and its timing, in addition to absolute HbA1C values, should be monitored

Predictors of long-term (10-year) mortality postmyocardial infarction: Age-related differences. Soroka Acute Myocardial Infarction (SAMI) Project

AbstractBackgroundCardiovascular diseases are the leading cause of death in elderly people. Over the past decades medical advancements in the management of patients with acute myocardial infarction (AMI) led to improved survival and increased life expectancy. As short-term survival from AMI improves, more attention is being shifted toward understanding and improving long-term outcomes.AimTo evaluate age-associated variations in the long-term (up to 10 years) prognostic factors following AMI in “real world” patients, focusing on improving risk stratification of elderly patients.MethodsA retrospective analysis of 2763 consecutive AMI patients according to age groups: ≤65 years (n=1230) and >65 years (n=1533). Data were collected from the hospital's computerized systems. The primary outcome was 10-year postdischarge all-cause mortality.ResultsHigher rates of women, non-ST-elevation AMI, and most comorbidities were found in elderly patients, while the rates of invasive treatment were lower. During the follow-up period, mortality rate was higher among the older versus the younger group (69.7% versus 18.6%). Some of the parameters included in the interaction multivariate model had stronger association with the outcome in the younger group (hyponatremia, anemia, alcohol abuse or drug addiction, malignant neoplasm, renal disease, previous myocardial infarction, and invasive interventions) while others were stronger predictors in the elderly group (higher age, left main coronary artery or three-vessel disease, and neurological disorders). The c-statistic values of the multivariate models were 0.75 and 0.74 in the younger and the elder groups, respectively, and 0.86 for the interaction model.ConclusionsLong-term mortality following AMI in young as well as elderly patients can be predicted from simple, easily accessible clinical information. The associations of most predictors and mortality were stronger in younger patients. These predictors can be used for optimizing patient care aiming at mortality reduction

When More Means Less: The Prognosis of Recurrent Acute Myocardial Infarctions

Recurrent acute myocardial infarctions (AMI) are common and associated with dismal outcomes. We evaluated the clinical characteristics and the prognosis of AMI survivors according to the number of recurrent AMIs (ReAMI) and the time interval of events (TI). A retrospective analysis of patients who survived following hospitalization with an AMI throughout 2002–2017 was conducted. The number of ReAMIs for each patient during the study period was recorded and classified based on following: 0 (no ReAMIs), 1, 2, ≥3. Primary outcome: all-cause mortality up to 10 years post-discharge from the last AMI. A total of 12,297 patients (15,697 AMI admissions) were analyzed (age: 66.1 ± 14.1 years, 68% males). The mean number of AMIs per patient was 1.28 ± 0.7; the rates of 0, 1, 2, ≥3 ReAMIs were 81%, 13.4%, 3.6% and 1.9%, respectively. The risk of mortality increased in patients with greater number of AMIs, HR = 1.666 (95% CI: 1.603–1.720, p p p < 0.001). The risk of mortality following AMI increased as the number of ReAMIs increased, and the TI between the events shortened. These findings should guide improved surveillance and management of this high-risk group of patients (i.e., ReAMI)

Long-term follow-up of high-pressure injection injuries to the hand

High-pressure injection injury is an injury caused by accidental injection of substances by industrial equipment. This injury may have devastating sequelae. The goal of this study was to assess the long-term outcome of high-pressure injection injury to the hand. In this historical prospective study, patients who had previously sustained high-pressure injection injury were examined. Assessment included measurement of grip and pinch strength, range of motion, two-point discrimination, and use of a questionnaire regarding present complaints and return to the work force. Twenty-three patients were examined. Follow-up length was on average 8.5 years. The injured hand was most often (43 percent) the right dominant hand, the index in 65 percent, the thumb in 25 percent, and other locations in 10 percent. Only 43 percent of patients returned to their previous employment. Patient complaints were, in descending frequency, cold intolerance, hypersensitivity, paresthesias, constant pain, and impairment of activities of daily living. Metacarpophalangeal range of motion was decreased on average by 8.1 percent (p = 0.019), proximal interphalangeal joint range of motion was decreased by 23.9 percent (p = 0.001), and distal interphalangeal range of motion was decreased by 29.7 percent (p= 0.018). Maximum grip was decreased compared with the expected grip by 12 percent (p = 0.023). Pinch was decreased by 35 percent (p < 0.001). Two-point discrimination was increased by 49 percent (p < 0.007). This study confirms the fact that high-pressure injection injury to the hand is a significant problem. Virtually all patients suffer sequelae of this injury. The injury has significant repercussions for future function and reintegration into the work forc

Associations between Subsequent Hospitalizations and Primary Ambulatory Services Utilization within the First Year after Acute Myocardial Infarction and Long-Term Mortality

Healthcare resource utilization peaks throughout the first year following acute myocardial infarction (AMI). Data linking the former and outcomes are sparse. We evaluated the associations between subsequent length of in-hospital stay (SLOS) and primary ambulatory visits (PAV) within the first year after AMI and long-term mortality. This retrospective analysis included patients who were discharged following an AMI. Study groups: low (0&ndash;1 days), intermediate (2&ndash;7) and high (&ge;8 days) SLOS; low (&lt;10) and high (&ge;10 visits) PAV, throughout the first post-AMI year. All-cause mortality was set as the primary outcome. Overall, 8112 patients were included: 55.2%, 23.4% and 21.4% in low, intermediate and high SLOS groups respectively; 26.0% and 74.0% in low and high-PAV groups. Throughout the follow-up period (up to 18 years), 49.6% patients died. Multivariable analysis showed that an increased SLOS (Hazard ratio (HR) = 1.313 and HR = 1.714 for intermediate and high vs. low groups respectively) and a reduced number of PAV (HR = 1.24 for low vs. high groups) were independently associated with an increased risk for mortality (p &lt; 0.001 for each). Long-term mortality following AMI is associated with high hospital and low primary ambulatory services utilization throughout the first-year post-discharge. Measures focusing on patients with increased SLOS and reduced PAV should be considered to improve patient outcomes