Purpose The Elipse balloon is a novel, non-endoscopic option for weight loss. It is swallowed and filled with fluid. After 4 months, the balloon self-empties and is excreted naturally. Aim of the study was to evaluate safety and efficacy of Elipse balloon in a large, multicenter, population. Materials and Methods Data from 1770 consecutive Elipse balloon patients was analyzed. Data included weight loss, metabolic parameters, ease of placement, device performance, and complications. Results Baseline patient characteristics were mean age 38.8 ± 12, mean weight 94.6 ± 18.9 kg, and mean BMI 34.4 ± 5.3 kg/m2. Triglycerides were 145.1 ± 62.8 mg/dL, LDL cholesterol was 133.1 ± 48.1 mg/dL, and HbA1c was 5.1 ± 1.1%. Four-month results were WL 13.5 ± 5.8 kg, %EWL 67.0 ± 64.1, BMI reduction 4.9 ± 2.0, and %TBWL 14.2 ± 5.0. All metabolic parameters improved. 99.9% of patients were able to swallow the device with 35.9% requiring stylet assistance. Eleven (0.6%) empty balloons were vomited after residence. Fifty-two (2.9%) patients had intolerance requiring balloon removal. Eleven (0.6%) balloons deflated early. There were three small bowel obstructions requiring laparoscopic surgery. All three occurred in 2016 from an earlier design of the balloon. Four (0.02%) spontaneous hyperinflations occurred. There was one (0.06%) case each of esophagitis, pancreatitis, gastric dilation, gastric outlet obstruction, delayed intestinal balloon transit, and gastric perforation (repaired laparoscopically). Conclusion The Elipse™ Balloon demonstrated an excellent safety profile. The balloon also exhibited remarkable efficacy with 14.2% TBWL and improvement across all metabolic parameters.

BackgroundLittle is known about Emergency Medical Services (EMS) use and pre-hospital triage of patients with acute ST-elevation myocardial infarction (STEMI) in Arabian Gulf countries.MethodsClinical arrival and acute care within 24 h of STEMI symptom onset were compared between patients transferred by EMS (Red Crescent and Inter-Hospital) and those transferred by non-EMS means. Data were retrieved from a prospective registry of 36 hospitals in 6 Arabian Gulf countries, from January 2014 to January 2015.ResultsWe enrolled 2,928 patients; mean age, 52.7 (SD ±11.8) years; 90% men; and 61.7% non-Arabian Gulf citizens. Only 753 patients (25.7%) used EMS; which was mostly via Inter-Hospital EMS (22%) rather than direct transfer from the scene to the hospital by the Red Crescent (3.7%). Compared to the non-EMS group, the EMS group was more likely to arrive initially at a primary or secondary health care facility; thus, they had longer median symptom-onset-to-emergency department arrival times (218 vs. 158 min; p˂.001); they were more likely to receive primary percutaneous coronary interventions (62% vs. 40.5%, p = 0.02); they had shorter door-to-needle times (38 vs. 42 min; p = .04); and shorter door-to-balloon times (47 vs. 83 min; p˂.001). High EMS use was independently predicted mostly by primary/secondary school educational levels and low or moderate socioeconomic status. Low EMS use was predicted by a history of angina and history of percutaneous coronary intervention. The groups had similar in-hospital deaths and outcomes.ConclusionMost acute STEMI patients in the Arabian Gulf region did not use EMS services. Improving Red Crescent infrastructure, establishing integrated STEMI networks, and launching educational public campaigns are top health care system priorities.

Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.

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Background: Treatment and control of blood pressure (BP) may improve outcomes in patients with heart failure (HF) with preserved and reduced ejection fraction. Updated AHA/ACC/HFSA guidelines from 2017 added a recommendation to target a systolic BP less than 130mm Hg for those with Stage C HF regardless of ejection fraction (Class of recommendation I, level of evidence C). Nationally representative data regarding rates of BP treatment and control in ambulatory HF patients are needed to identify gaps in achieving this goal and determine if racial disparities exist. Hypothesis: Treatment and control rates of BP are low in those with HF and vary by race. Methods: We evaluated BP treatment and control rates in adults age 20 years who identified as non-Hispanic (NH) black, NH white, or Hispanic with self-reported HF from the National Health and Nutrition Examination Surveys (NHANES) 1999-2016. We determined prevalence rates of BP treatment and control by race. Control BP (for those on BP treatment) or goal BP (for those not on BP treatment) was defined as <130/80 mm Hg. Odds ratios (OR) and 95% confidence intervals (CI) of control or goal BP of NH Black and Hispanic adults compared to NH whites were calculated with adjustment for age, sex, and proxies of SES (education level, health insurance, and income). All analyses accounted for the complex-weighted sampling design of NHANES. Results: Among 1240 adults with HF, mean age was 66 §0.5 years and 48% were female, 14% NH black, 9% Hispanic, and 69% were on BP treatment. Rate of BP treatment was highest in NH blacks (82%) compared with NH whites (65%) or Hispanics (55%) (p <0.001). However, the proportion of BP control among those on BP treatment was lowest among NH blacks (39%) compared with NH whites (51%) or Hispanic adults (45%). Among those not on BP treatment, there were no significant differences in rates of goal BP by race (NH blacks [41%], NH whites [53%], and Hispanics [57%]). After adjustments for age, sex, and SES, the OR (95% CI) of BP control for NH blacks on treatment was 0.62 (0.43, 0.91) compared to NH whites (TABLE ). Conclusions: Despite the fact that patients with HF constitute a high-risk population, we found low rates of BP treatment and control (defined by <130/80mm Hg). There was significant discordance between rates of treatment and control among NH blacks who had the highest rates of treatment but the lowest rates of BP control while on treatment. Focused efforts are needed to achieve the BP target set by the 2017 AHA/ACC/HFSA guidelines with attention towards eliminating disparities.