Background: White coat hypertension (WCH) is a condition in which people exhibit an elevation in blood pressure (BP) in a clinical setting, although they do not show such elevation in other settings. This study aims to provide new insight into determining the prevalence of WCH amongst patients with or without any cardiovascular risk. Method: This is a cross-sectional study of convenience sampling study design where 300 patients were involved based on their consultation to a Tertiary Healthcare Unit between November 2021 to March 2022 in Erbil city. Patients were classified according to the ESC into different categories of BP patterns by comparing the first BP reading that was taken at clinic with their average AMBP readings which were taken at home. Results: A total of 300 patients were included in the study where 58% of the population was male and 42% of the population was female. Of the population, 16% had WCH, 12.3% had sustained HTN, 59.3% were considered to be normotensive (NT), and 12.3% among them were categorized as masked hypertension. From the total of 47 patients that were diagnosed with WCH, 55.3% were male and 44.7% were female patients. The overall average Systolic Blood Pressure in WCH was 125.79±15.30 mmHg, and in Hypertensives it was 147.70±17.15 mm Hg with a P-value of <0.001. The Mean Arterial Pressure in WCH was 94.63±8.87 mmHg and in Hypertensives it was 112.16±13.62 mmHg with a P-value of <0.001. The average Pulse Pressure in WCH was 75.27±9.42 mmHg, and in Hypertensives it was 76.35±9.11 mmHg with a P-value of 0.001. Conclusion: WHC is significantly prevalent in Erbil city; therefore AMBP monitoring should be performed for those with certain indications to limit the prescription of unnecessary long-term medications with possibly significant side effects to patients with WHC.

Background: Sick sinus syndrome (SSS), also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. Sick Sinus Syndrome is a highly relevant clinical entity, being responsible for the implantation of the majority of electronic pacemakers worldwide. Case Summary: An 80-year-old patient with a recent diagnosis of atrial fibrillation after a syncopal attack, presented to our clinic complaining of new onset lightheadedness. Following a pre-syncopal attack in our clinic, extensive analysis was performed and showed no underlying causes for the light headedness. A 24-hour Holter monitoring was performed and demonstrated signs of sick sinus syndrome with unusually prolonged sinus pauses without an escape rhythm. Urgent correction with permanent dual chamber pacemaker was performed with an uneventful postoperative recovery. Discussion: In sick sinus syndrome, cessation of sinus rhythm (sinus arrest) for short intervals without an escape rhythm, or longer periods of pause with replacement of sinus rhythm by an atrial or junctional rhythm are commonly seen. However, recurrent prolonged ventricular asystolic episodes are infrequently encountered and an extremely rare cause of syncope. It is known that triggers like anaesthesia, certain drugs or epilepsy can unmask sinus node dysfunction, which then manifests as significant atrial dysrhythmias and “rarely” asystole but long asystolic episodes of such duration were never reported in the absence of any trigger in patients with sick sinus syndrome. Permanent pacemaker placement is the recommended treatment for sick sinus syndrome.

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Objective: This study aims to assess the ability and the safety of fasting among patients who underwent PPCI within two specified periods. Methods: This study was a Retrospective Cohort Study with a convenience sample size of 200 consecutive patients who were divided into two groups based on the duration of their last primary PCI for an attack of acute myocardial infarction (AMI) and the start of the month of Ramadan. The patients were admitted to the Causality Department of the Surgical Specialty Hospital-Cardiac Center, Erbil/Iraq. Group I included patients undergone PPCI 6 weeks or less before the start of Ramadan while group II included patients undergone PPCI for more than 6 weeks before the start of the fasting month of Ramadan. Furthermore, each of these two groups was subdivided based on their ability to complete the Ramadan Intermittent Fasting (RIF) with no recurring or worsening of symptoms into those who fasted the whole Ramadan month, those who did not fast, those who could not continue fasting, and those who passed away. At the end of the RIF, patients’ symptoms were recorded along with their status according to the New York Heart Association (NYHA). Results: In a comparison of the proportion of fasting and non-fasting patients among the two groups, 14% in group I were able to complete the 30 days of intermittent fasting during the Ramadan month while this percentage in group II was 54% (P-value=0.001). Among our findings, there were significant associations between post-PCI symptoms (exertional shortness of breath and palpitations) and RIF (P-values=0.001and P-values=0.004, respectively). With regards to New York Heart Association (NYHA) classifications assessment, Group I had a higher proportion of patients classified as Class III and Class IV compared to Group II (P-value=0.001) meaning patients were more symptomatic during the lesser interval between the start of the fasting month and the primary PCI.  Conclusion: Patients with PPCI within the first 6 weeks after the procedure, as well as patients with NYHA class III, are at a higher risk for health deterioration and are advised not to observe RIF.

Background:Patients on Polypharmacy regime due to having a chronic illness are at a higher risk of developing some form of negative psychological outcome as a result of their disease. This study aims to determine the impact of polypharmacy on the psychological aspects of a patient living with a chronic disease.Method:A case-control study conducted amongst patients in an outpatient clinic of an Internist (July 1st to September 1st, of 2021) in the city of Erbil, Iraq. Data was extracted from a self-assessed questioner. 200 participants were divided into polypharmacy (case group) and non-polypharmacy group (control group). Polypharmacy, being defined as the use of 5 or more medication which meant that participants in the case group must fit into these criteria. A ‘Hospital Anxiety and Depression Scale’ (HADS) was used to determine the presence of symptoms of depression and/or anxiety.Results:A totally of 200 patients were included in the study. Of these 100 participants were from the non-polypharmacy group while the remaining 100 were from the polypharmacy group. Of these, depression among non-polypharmacy group (control) participants were 11% while 76% were found to be non-cases of depression. Compared to that, 31% of the polypharmacy group had depression while 51% were non-cases for depression. Also. the prevalence of depression and anxiety was increasing with an increase in number of medications taken by the patients. Depression was present in 11% of patients who took 4 or less medications while the prevalence increased to 21.1%, 34.9% and 42.1% in patients who took five, six to eight, and more than nine medications, respectively.Conclusion: There is a significant link between polypharmacy and psychological distress in patients with chronic diseases with a focus on depression and anxiety. Healthcare providers can help in detecting polypharmacy and in providing recommendations for simplifying medication regimes and reducing the outcomes of chronic diseases. Trial registration: - This article doesn’t contain any health care intervention on human participants.