No abstract

Background: Percutaneous coronary intervention (PCI) is increasingly used in the management of acute coronary syndromes (ACSs). PCI has decreased the demand for coronary artery bypass grafting, and more patients with ACS are now undergoing PCI. No previous data about the characteristics and outcome of patients performing PCI in Yemen. This study aimed to assess the patient presentation, characteristics, and outcome among Yemeni patients having PCI in the Military Cardiac Center. Methods: All patients who underwent PCI either primary or elective in the Military Cardiac Center in Sanaa City were included over 6 months. Clinical, demographic, procedural, and outcome data were extracted and analyzed. Results: During the study period, 250 patients underwent PCI. The mean ± standard deviation age was 57 ± 11 years, with 84% being male. Of all the patients, 61.6% (156) smoked tobacco, 56% (140) had hypertension, 37% (93) had Type 2 diabetes, 48.4% (121) had hyperlipidemia, and 8% (20) had a family history of ischemic heart disease. Coronary artery presentation was in the form of acute ST-elevation myocardial infarction at 41% (102), non-STEMI at 5.2% (58), stable angina at 31% (77), and unstable angina at 5.2% (13). Coronary artery interventions were elective PCI in 81% (203), emergency in 11% (27), and urgent in 8% (20) with only 3% radial artery access and 97% femoral access. PCI was mainly in the left anterior descending artery in 82% (179), right coronary artery in 41% (89), left circumflex artery in 23% (54), and left main in 1.25% (3). All stents were drug-eluting stents during the registry time. Complication occurred in 17.6% (44) and case fatality was 2% (5). Conclusions: Despite the current situation in Yemen, PCI was performed with success in a large number of patients with a low incidence of inhospital complications and mortality that is comparable to high- or middle-income settings.

Background: Health education and lifestyle modifications re as important as pharmacotherapy in management of diabetes mellitus. It is suggested that healthcare education would aid in controlling glycaemic measures among diabetic patients especially in critical situations during postoperative periods. The aim of this study was to explore the impact of healthcare education program on diabetic patients who underwent cardiac surgery in Jeddah.Methods: This was a prospective cohort study that was conducted in King Fahd armed forces hospital in Jeddah during the period 2009-2017 on 387 patients. Baseline Hemoglobin A1c was tested for all patients on regular basis (at 0, 3, 6, and 12 months), then a healthcare educational program was started followed by subsequent measurement of Hemoglobin A1c at the same time intervals. Comparisons between the Hemoglobin A1c before and after the program were made.Results: There were no significant differences as regards Hemoglobin A1c levels among the studied patients before and after healthcare education (p=0.087). However, on regression analysis, educational program establishment was significantly correlated with lower Hemoglobin A1c levels among the patients (OR=0.43 (0.32-0.49), p<0.0001).Conclusions: Healthcare educational programs can have a positive impact on improving Hemoglobin A1c control among diabetic patients after cardiac surgery.

Context Several studies comparing flow and pressure triggering using invasive and noninvasive techniques have mostly focused on the trigger phase and favored flow triggering. Recently, there have been advancements in the technology of pressure triggering to improve its performance. Aims We sought to evaluate the effect of triggering type in old and new ventilators on patient’s synchrony in the post-trigger phase using variations in airway pressures with the set inspiratory pressure as a surrogate for dyssynchrony. Patients and methods Using three different ventilator types, 32 patients on pressure support ventilation were set on the two triggering types (at the same equivalent levels), each for 1 h, with all other ventilatory setting kept constant. At the end of the hour on each trigger mode, the measured peak pressure and its difference with the set inspiratory pressure [delta pressure (ΔP)], the mean airway pressure, and different ventilatory parameters and arterial blood gases were assessed. Results Pressure triggering resulted in a significantly higher peak pressure, ΔP, and lower dynamic compliance at any equivalent sensitivity and pressure support regardless of the level (<0.05). Moreover, at higher sensitivity levels (3 cmH2O and l/min), flow triggering produced higher mean airway pressures and oxygenation (<0.05). However, there was no significant difference as regards tidal volume, minute volume, frequency, rapid shallow breathing index, or PCO2. Conclusion Despite advances in pressure-triggering technology, flow triggering results in less pressure variation and better patient’s synchrony during pressure support ventilation; in this respect, ΔP and dynamic compliance are simple noninvasive measures for dyssynchrony.