Prevalence of renal impairment in decompensated heart failure patients at King Hussein medical center

To determine prevalence of renal impairment associated with chronic heart failure, defined as cardiorenal syndrome, in patients treated at King Hussein Medical Center. This retrospective review was carried out at King Hussein Medical Center between first of January 2005 and the first of January 2007. All heart failure patients who were admitted because of decompensated heart failure state were included. Medical records were reviewed and data was obtained regarding age, sex, body weight, serum creatinine, echocardiography findings, use of angiotensin converting enzyme inhibitors as well as diuretics, and any documentation of atrial fibrillation in the medical records. Estimated glomerular filtration rate was calculated for all patients. Five hundred patients met the inclusion criteria. The male to female ratio was 3:2 and their average age was 61 years [ +/- 9.1 years]. Two hundred and ten patients [42%] had moderate to severe left ventricular dysfunction [ejection fraction below 35%], and 290 [58%] were having mild left ventricular dysfunction [ejection fraction more than 35%]. Four hundred [80%] of heart failure patients were on angiotensin converting enzyme inhibitors and diuretics. Two hundred patients had documented atrial fibrillation in their medical records. Estimated glomerular filtration rate above 90ml/min was found in 350 patients [70%], a rate between 60-90ml/min was found in 70 patients [14%], a rate between 30-59 ml/mm was found in 45 patients [9%], and a rate below 30 ml/mm was detected in 35 patients [7%]. The average age of patients with estimated glomerular filtration rate below 90ml/min was 68 years +/- 4 years with a male to female ratio of 3:2 and 65% of them were having moderate to severe left ventricular impairment. Seventy five percent of patients with estimated glomerular filtration rate below 90ml/min were having documented atrial fibrillation in their medical records. Angiotensin converting enzyme inhibitors and diuretics were used in 80% of those with estimated glomerular filtration rate below 90ml/min. Among the decompensated heart failure patients included in the study, 15 [3%] died during hospitalization and 10 of them [66%] were having estimated glomerular filtration rate below 30ml/min. In patients undergoing intensive treatment for heart failure, renal dysfunction is common and clinically significant. Better understanding of the causes and prevention of renal dysfunction during heart failure therapy may lead to better outcomes in the future

Malaria cases among Jordanian medical team on prophylactic mefloquine in Sierra Leone

To describe malaria outbreak among medical Jordanian team members participating in Peacekeeping Forces in Sierra Leone. This is a retrospective review of 119 Military Jordanian males 32 of them [26%] were officers and the rest were enlisted. The mission started in January 2002 and ended in July 2002. Strict regulations were taken to ensure that prophylactic mefloquine was taken on time and the measures against the vector were applied rigorously. Thick and thin blood smears for malaria were adopted whenever a case of malaria was suspected. In many cases, the test was repeated several times. Due to the nature of the mission, which included internist physicians available 24 hours, the members were supervised continuously for any complication. Out of the 119 members of the team, 18 [15.1%] had malaria during this mission period. The species was Plasmodium falciparum. All patients responded to treatment except one case, which was labeled as multi-drug resistant and subsequently was repatriated. Compliance was nealy complete with melfloquine chemoprophylaxis. The number of cases declined remarkably after revising and improving the measures against the malaria vector [15 vs. 3]. In malarious area, chemoprophylaxis with melfoquine is not enough to prevent infection, but it may ameliorate the clinical course. Drastic measthe against the vector must be deployed to reduce the incidence of this disease

Exercise testing of chest pain patients in emergency department at prince hashem military hospital

To describe patients with chest pain and their triage in the emergency department after using treadmill exercise testing when needed. This study was conducted during the period between 15th of August 1999 and 15 th of July 2000 as indicated by clinical and electrocardiographical ceiteria in a large heterogeneous group, which excluded patients with proven coronary artery disease. During the study period, a total of 450 patients with chest pain [[287[63.8%] males, 163 [36.2%] females]] presented to the emergency department underwent treadmill testing. Fifty patients [11.1%] had positive results on exercise electrocardiography, 42 of the latter the further evaluation that revealed evidence of coronary artery disease in 31 [73.8%] patients. There hundred sixty nine [82%] patients had negative exercise test results and 31 [6.9]% had non-diagnostic tests. No adverse events were recorded. A 30-day follow-up achieved in 425 [94.4%] patients and revealed no mortality in any of the patients. The results in the study population support the safety and utility of exercise testing in low-risk chest pain patients who presented to the emergency department