management of elderly diabetic Saudi patients with acute coronary syndrome

Elderly Diabetics [DM] who present with Acute Coronary Syndrome [ACS] constitute a very high risk group. We present the pattern of management of elderly patients [65 years] in the Kingdom of Saudi Arabia [KSA] in comparison to the international data extrapolated from a Multicenter International Diabetes-Acute Coronary Syndromes [MIDAS]. DM patients presenting with unstable angina or non-ST-segment elevation myocardial infarction [MI] at the time of admission to the hospital were collectively enrolled into the MIDAS study. A total of 3624 patients were enrolled; 142 were from Saudi Arabia. Primary clinical outcome measure was in-hospital death or MI. We present the data of KSA based on the age of the patients in comparison to the international registry. Baseline characteristics were typical for DM presenting with ACS, with mean age of 67 +/- 15 years, males, constituted 36% of patients while 94% of patients were DM type 2. There was marked underutilization of glycoprotein IIb/IIIa inhibitors in those aged over 65 years with a decrease from 22.5 to 12.7 in KSA [Odds ratio 0.56] patients. The percentage of early coronary angiography approach in KSA was less than that of the international data with further reduction of the percentage in Saudi elderly population [from 49.3% to 25.5% with Odds ratio 0.52]. In elderly Saudi diabetic patients admitted with ACS, there is tendency for underutilization of GP IIb/IIIa, early coronary angiography, and revascularization that needs to be addressed

Resting heart rate in patients with ischemic heart disease in Saudi Arabia and Egypt

To assess the level of resting heart rate [RHR] in an outpatient population presenting with stable coronary artery disease [CAD] as well as to measure its association with current therapeutic management strategies for cardiovascular events. A multi-center cross-sectional survey was carried out in Saudi Arabia and Egypt over a three month period [between January 2007 and April 2007]. 2049 patients with CAD without clinical heart failure [HF] were included in this study through "cluster sampling". RHR was measured by manual palpitation. Mean age of CAD patients was 56.7 +/- 10.4 and the mean RHR was 78.9 +/- 13.9 b/m. 1686 patients [83.1%] were on beta -blockers for whom the RHR was 78.5 +/- 14.0 b/m [95.5% had RHR >/= 60 b/m, which is higher than recommended by the guidelines]. 1094 [73.5%] of patients on beta -blockers were on a lower dose, probably to avoid the complications associated with such a class. Among those not on beta-blockers [16.9%], RHR was 80.9 +/- 13.0 b/m. Moreover, 98 patients [4.8%] were on calcium channel blocker [diltiazem or verapamil] but not on beta-blockers, for whom the RHR was 80.9 +/- 12.0 b/m. Finally, 163 patients [8.0%] were on both beta-blockers and the calcium channel blocker, and their RHR was 79.0 +/- 14.4 b/m. Optimal target RHR has not been achieved in a significant number of screened patients. Achievements of such targets are known to decrease mortality and to improve survival

Unusual cause of hepatosplenomegaly

Tuberculosis [TB] and its complications are increasing public health problems in many parts of the world, especially in immunocompromised patients. The disease has wide spectrum oi presentations which necessitate its consideration in differential diagnosis of unresolved clinical problems particularly in developing countries. It is infrequently encountered in developed countries, hence a high index of suspicion is required. However, in developing countries where TB is endemic, the facilities for accurate and timely diagnosis of extrapulmonary TB are lacking and not readily available. Here we report an unusual case of hepatosplenomegaly due to TB with an insidious presentation

Chronic eosinophilic pneumonia in a Saudi patient

Chronic eosinophilic pneumonia [CEP] is a rare disorder that was first reported in 1960 but the syndrome was best described by Corrington et al in 1969. To our knowledge, no single Saudi case has been reported up to the present date