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

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

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

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.

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

Takayasu’s Arteritis Associated with Tuberculosis in a Young Yemeni Woman

Takayasu’s arteritis (TA) is an autoimmune disease that affects the big arteries. A possible relationship between TA and tuberculosis (TB) has been suggested. Both diseases have similar chronic inflammatory lesions and occasionally granulomas on the arterial walls. We report a case of TA associated with TB

Khat chewing, cardiovascular diseases and other internal medical problems : The current situation and directions for future research

The leaves of khat (Catha edulis Forsk.) are chewed as a social habit for the central stimulant action of their cathinone content. This review summarizes the prevalence of the habit worldwide, the actions, uses, constituents and adverse health effects of khat chewing. There is growing concern about the health hazards of chronic khat chewing and this review concentrates on the adverse effects on health in the peripheral systems of the body, including the cardiovascular system and gastrointestinal tract. Comparisons are made with amphetamine and ecstasy in particular on the detrimental effects on the cardiovascular system. The underlying mechanisms of action of khat and its main constituent, cathinone, on the cardiovascular system are discussed. Links have been proposed between khat chewing and the incidence of myocardial infarction, dilated cardiomyopathy, vascular disease such as hypertension, cerebrovascular ischaemia and thromboembolism, diabetes, sexual dysfunction, duodenal ulcer and hepatitis. The evidence, however, is often based on limited numbers of case reports and only few prospective controlled studies have been undertaken. There is therefore an urgent need for more thorough case-control studies to be performed. This review outlines the current knowledge on the adverse health effects of khat chewing on the cardiovascular system and other internal medical problems, it assesses the evidence and the limitations of the studies and identifies the questions that future studies should address