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91.
OBJECTIVE: We studied the clinical epidemiological features of patients with AMI treated at a major hospital in Kuwait. The objectives of the study were to determine (i) personal and clinical characteristics of patients; (ii) prevalence of major risk factors among the patients; and (iii) factors associated with in-hospital morbidity and mortality. METHODS AND RESULTS: All patients (n = 126) who fulfilled the standard diagnostic criteria for AMI and treated at the CCU of the study hospital during the calendar year 1996 were included in the study. Patients were identified from the CCU register and information was extracted from the medical records. Multiple logistic regression was performed to study the factors independently associated with in-hospital morbidity and mortality. Of the 126 patients, 84.9% were men and 15.1% were women; and 40.5% were Kuwaiti nationals and 59.5% were expatriates. On average, male patients were younger than females (mean age = 52.4 +/- 10.4 years vs. 60.2 +/- 10.2 years), and male expatriates were the youngest sub-group in the study (mean age = 49.7 +/- 8.7 years). Overall, history of diabetes, hypertension, and CHD was recorded in 44.4%, 29.6%, and 16.8% of the patients, respectively. About 58% of the male patients were current smokers and the prevalence of smoking was significantly higher in expatriates compared with Kuwaiti patients (62% vs 36%, respectively). Kuwaiti nationals had a significantly high prevalence of diabetes compared with the expatriates (57% vs 36%, respectively). There was a significant trend in increasing prevalence of diabetes, hypertension and CHD with age whereas smoking was most prevalent (87%) in the youngest age group. As for the clinical features, 70.5% of the patients presented within 6 hours of the onset of symptoms, 73% presented with ST-segment elevation (40.5% with inferior, 32.5% with anterior ST-segment elevation), and fibrinolytic therapy was given to 63.6% of the patients. About half of the patients had an admission blood glucose level of > or = 10 mmol/l, and 70.6% had a fasting blood glucose level of > or = 6.1 mmol/l one day after admission. In the multiple logistic regression analysis, old age (> 60 years), anterior MI, and admission blood glucose level of > or = 10 mmol/l were found to be significantly associated with in-hospital cardiac morbidity. The in-hospital case fatality was about 6%. Old age and history of CHD were found to be the significant predictors of in-hospital mortality. CONCLUSION: Control of smoking and early diagnosis and appropriate treatment of diabetes may reduce the burden of AMI-related morbidity and mortality. 相似文献
92.
Memon A Moody PM Sugathan TN el-Gerges N al-Bustan M al-Shatti A al-Jazzaf H 《Bulletin of the World Health Organization》2000,78(11):1306-1315
INTRODUCTION: In 1996 we conducted a cross-sectional survey to study the epidemiology of smoking among Kuwaiti adults. METHODS: The 4000 participants were selected using a three-stage stratified cluster sampling design. Altogether 3859 participants (1798 males, 2061 females) returned a completed self-administered questionnaire. RESULTS: The prevalence of smoking was 34.4% (95% confidence interval (CI) = 32.2-36.6) among men and 1.9% (95% CI = 1.3-2.5) among women. Among men, the highest prevalence (56.5%; 95% CI = 36.2-76.8) was observed in the youngest age group (< or = 20 years). Among women the highest prevalence was observed in one of the older age groups (46-50 years) (7.1%; 95% CI = 3.1-11.1). Multiple logistic regression analysis showed that the following factors were independently associated with smoking: lower levels of education (odds ratio (OR) 3.5; 95% CI = 1.5-8.4), lower employment grade (OR = 4.1; 2.5-6.7), and being a separated, divorced, or widowed woman (OR = 4.9; 95% CI = 2.0-11.8). The majority of smokers (68%) began smoking when younger than 20 years; significantly more men (70%) than women (33%) began smoking at these ages (P < 0.0001). On average, men began smoking at an earlier age (18 years vs 21 years; P < 0.001) and therefore had smoked for a longer period (15 years vs 12 years; P < 0.05); men also consumed a higher number of cigarettes each day (26 vs 17; P < 0.05). A large proportion of smokers were ignorant about the health consequences of passive smoking: about 77% of those with children reported that they smoked in the presence of their children. Almost half (47%) of all smokers stated that they wanted to stop smoking, and about 56% had attempted to quit. The biggest perceived barrier to quitting was uncertainty about "how to quit". A total of 338 respondents (8.8%; 95% CI = 5.8-11.9) were classified as former smokers. About half of the former smokers had quit between the ages of 20 and 29 years; the average age of quitting was 28 years. Former smokers were more likely to have smoked fewer cigarettes per day and to have smoked for significantly less time than current smokers. DISCUSSION: Given the fact that free education is provided at all levels by the government, anti-tobacco education and awareness should be included as an integral part of the curriculum in schools and colleges. 相似文献
93.
Memon M Abbas F Khaonolakar M Dixon J Singh I 《Journal of the Royal Society of Medicine》2002,95(6):293-295
A key issue in health provision is the approach to health inequalities. In the UK, black and ethnic minority populations are disadvantaged in this respect. We obtained annual/public health reports from 13 health authorities (HAs) and 22 primary care trusts/groups (PCT/Gs) serving conurbations with large black and ethnic minority populations, and examined them for mention of special health issues for these groups and the action being taken. 22 of the 35 reports referred to such issues but only 17 referred to special initiatives; the most frequently mentioned were diabetes and coronary heart disease. We recommend that HAs and PCT/Gs serving large black and ethnic minority populations state specifically in their annual reports their awareness of health-equality issues and the action being taken to address them. 相似文献
94.
95.
Corticosteroid-sparing effect of intravenous immunoglobulin therapy in patients with pemphigus vulgaris 总被引:7,自引:0,他引:7
BACKGROUND: Pemphigus vulgaris (PV) is a rare, potentially fatal autoimmune mucocutaneous blistering disease. The prolonged use of systemic corticosteroids, though clinically effective in high doses, can result in multiple debilitating adverse effects. Immunosuppressive agents, used as adjuvants and as corticosteroid-sparing agents, are not effective in all patients and are contraindicated in some. Therefore, alternative treatment modalities are needed to provide effective control of PV in such patients. OBJECTIVE: To demonstrate the corticosteroid-sparing effect of intravenous immunoglobulin (IVIg) therapy in patients with moderate to severe PV. DESIGN: A retrospective analysis in a cohort of 15 patients with moderate to severe PV who were treated with IVIg therapy. All 15 patients were corticosteroid dependent, and the use of other systemic conventional immunosuppressive agents was contraindicated. The patients were followed up over a mean period of 6.2 years. SETTING: Ambulatory tertiary medical care facility of a university-affiliated hospital. INTERVENTION: All 15 patients received an IVIg dose of 1 to 2 mg/kg per cycle. MAIN OUTCOME MEASURES: The following information was documented in each of the 15 patients before and after the initiation of IVIg therapy: total dosage and total duration of prednisone therapy and number of relapses. Also, the highest dosage and adverse effects of prednisone therapy, as well as the total duration of observation, were recorded. RESULTS: All 15 patients had a satisfactory clinical response to IVIg therapy. The use of systemic prednisone was gradually discontinued over a mean period of 4.3 months. A statistically significant difference was noted in the total dose of prednisone (P =.004), total duration of prednisone therapy (P =.003), and number of relapses (P<.001) before and after the initiation of IVIg therapy. CONCLUSIONS: Intravenous immunoglobulin therapy has a demonstrable corticosteroid-sparing effect. It is a safe and effective alternative treatment modality in patients with PV who are dependent on systemic corticosteroids or who develop significant adverse effects as a result of their use. 相似文献
96.
Mohan Kameswaran S. Raghunandhan Kiran Natarajan Naveed Basheeth 《Indian journal of otolaryngology and head and neck surgery》2006,58(1):69-73
This retrospective study is based on the assessment of outcomes of Cochlear Implantation taking into account various scoring systems like Category of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). 100 candidates who were implanted between June 1997-June 2005 at Madras ENT Research Foundation (MERF), a tertiary referral center for cochlear implantation were included in the study. The results were analyzed using the above scoring systems to assess the performance levels of each implantee and to arrive at a cumulative result on the outcome of the implantation. Practical issues of concern to Cochlear Implantation in the Indian subcontinent were also analyzed. 相似文献
97.
Postureteroscopy colic, accumulation of irrigant fluid in the bladder, and advancement of the ureteroscope through narrow ureters are some of the problems commonly encountered during ureteroscopy. Three methods to overcome these problems and to make ureteroscopy technically easy, safe and cost-effective are described. 相似文献
98.
99.
Combined autologous cellular cardiomyoplasty with skeletal myoblasts and bone marrow cells in canine hearts for ischemic cardiomyopathy 总被引:11,自引:0,他引:11
Memon IA Sawa Y Miyagawa S Taketani S Matsuda H 《The Journal of thoracic and cardiovascular surgery》2005,130(3):646-653
OBJECTIVES: Cellular cardiomyoplasty with isolated skeletal myoblasts and bone marrow mononuclear cells is an encouraging therapeutic strategy for heart failure. We investigated the achievements accomplished with combined cell therapy of skeletal myoblast and bone marrow mononuclear cell transplantation to the ischemic canine myocardium. METHODS: Autologous skeletal myoblasts (1 x 10(8)) and autologous bone marrow mononuclear cells (3 x 10(6)) were injected directly into the damaged myocardium of canine hearts that had undergone 2 weeks of left anterior descending coronary artery ligation. Treatment groups were as follows: skeletal myoblasts plus bone marrow mononuclear cells (combined cell therapy, n = 4), myoblasts (n = 4), bone marrow mononuclear cells (n = 4), and medium only (n = 4). In similarly designed supporting experiments, angiogenic factor expression was evaluated by enzyme-linked immunosorbent assay after cell transplantation in rat hearts that had undergone left anterior descending coronary artery ligation. RESULTS: Four weeks after cell implantation, echocardiography demonstrated better cardiac performance with reduced left ventricular dilation and significantly improved ejection fraction in the combined cell therapy group compared with that seen in the other groups (pretreatment, 37.7% +/- 1.1%, vs combined cell therapy, 55.4% +/- 8.6%; myoblasts, 47.4% +/- 7.4%; bone marrow mononuclear cells, 44.4% +/- 6.7%; medium only [control], 34.4% +/- 5.4%; P < .05). A significantly high number of neovessels were observed in the group receiving combined cell therapy only (combined cell therapy, 45.5 +/- 12 x 10(2)/mm2; myoblasts, 26.5 +/- 8 x 10(2)/mm2; bone marrow mononuclear cells, 30.7 +/- 15 x 10(2)/mm2; medium only [control], 7.1 +/- 1 x 10(2)/mm2; P < .05). Immunostained sections expressed the skeletal specific marker myosin heavy chain, although they did not express the cardiac specific marker troponin T. Results of enzyme-linked immunosorbent assay showed the highest expression of vascular endothelial growth factor (combined cell therapy, 2.9 +/- 0.7 ng/g tissue; myoblasts, 0.24 +/- 0.7 ng/g tissue; bone marrow mononuclear cells, 1.9 +/- 0.2 ng/g tissue; medium only [control], 0.19 +/- 0.004 ng/g tissue; P < .05) and hepatocyte growth factor in the combined cell therapy hearts. CONCLUSIONS: Combined autologous cellular therapy induced both myogenesis and angiogenesis with enhancement of cardiac performance and reduction of cardiac remodeling, suggesting a capable strategy for treating severe ischemic cardiomyopathy clinically. 相似文献
100.
Memon MA Mohanty S Das K Garg I D'Cruz AL 《Pediatric nephrology (Berlin, Germany)》2005,20(6):821-823
Hemihypertrophy is associated with malignant visceral abdominal neoplasms in childhood. Benign nephromegaly and nephroblastomas are both known to occur with hemihypertrophy; however, association with renal dysplasia has not previously reported. We describe an infant presenting with recurrent haematuria who had segmental hemihypertrophy, ipsilateral renal dysplasia and contralateral benign nephromegaly. Although debated, renal dysplasia may predispose to and predate malignant change. Rational management and optimal surveillance of renal dysplasia and benign nephromegaly in hemihypertrophy is discussed. 相似文献