ABSTRACT
Objectives: To assess the use of Midodrine among patients with orthostatic hypotension and withdrawal vasopressin in King Abdulaziz Medical City (KAMC), demonstrate the effectiveness and safety of Midodrine and detect side effects to provide clear evidence of the efficacy and safety of the drug. Methods: A retrospective cohort study was done in King Abdulaziz Medical City in Riyadh (Saudi Arabia). The study targeted adult patients who suffered from hypotension between January 2015 and January 2018. The data was extracted using the BESTCare system. Result: A total of 173 patients were included (55.5% male and 44.5% female). The mean age of the study participants was 67.34 ± 16.0 years. The differences in patients’ parameters before and after midodrine administration were detected and analyzed. The mean difference in hemoglobin (g/l) level was significantly changed before (94.97 ± 21.9) and after (90.84 ± 20.4) the use of Midodrine (p=0.031). However, there were no significant changes in the level of the other parameters before and after the use of Midodrine. The mean dose of Midodrine was 5.3 mg, with mean treatment duration of 41.5 days, and mean hospitalization of 28.7 days. For the medication history, 8% of patients were on betablockers (n=97), 5%were on diuretics (n=64), and 2% were on calcium channel blockers (n=19). Conclusion: Our data suggest that the administration of Midodrine does not affect patients’ hemodynamics significantly; however, it has a notable effect on decreasing hemoglobin levels.
ABSTRACT
Background: The incidence of Venous thromboembolism (VTE) in pregnant women is 4-5 times higher than that in non-pregnant women, and the risk is increased postpartum. There are limited studies that assess the awareness of VTE among at-risk pregnant and postpartum women. Methods: A quantitative cross-sectional study including a validated survey was administered to pregnant women in the outpatient clinic and those hospitalized for labor at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Results: Out of 340 participants, 57% correctly described the cause of deep vein thrombosis (DVT). Only 26.8% and 13.8% reported awareness of DVT and Pulmonary embolism (PE) respectively. About 32% of the participants who had previous knowledge about DVT, knew that swelling of the leg is one of its major symptoms, and only 25% recognized the shortness of breath as a major symptom of PE. Long periods of inactivity or undergoing surgery were correctly identified as key risk factors for developing a blood clot by only 20%, and 14.4% of the participants respectively, while 7.5% were aware that pregnancy or postpartum are risk factors for VTE. Though most participants (99.7%) agreed that blood clots can cause death, 90.3% believed that blood clots cannot be prevented. The educational level has a significant effect on participants’ awareness of DVT. Conclusion: This study demonstrates knowledge deficit and lack of awareness of VTE among pregnant and postpartum patients. More effort must be provided to increase the awareness of VTE risk to ensure safe and high-quality patient care.
ABSTRACT
Objective: Postoperative atrial fibrillation (POAF) is an arrhythmia most commonly seen after cardiac surgery. Its association with increased mortality, cost and adverse events has made it crucial to identify those at risk and to prevent POAF through preoperative therapy. In order to do that, we have studied the utilization and predictive power of the CHA2DS2-VASc score, and the relationship between other factors such as preoperative medications and patient clinical characteristics. Methods: A retrospective observational study was conducted by reviewing medical charts for patients who underwent coronary arteries bypass grafting (CABG) with or without aortic valve replacement or mitral valve/tricuspid valve repair and aged >18 years. Patients with a preoperative history of atrial fibrillation (AF) or flutter, patients with a pacemaker, patients with prior antiarrhythmic drugs use within the last 6 months, patients who underwent MAZE procedures, or patients with mechanical mitral valve were excluded. Results: At a cut-off score of ≥ 2 the CHA2DS2-VASc showed a 96.8% sensitivity and 23.1% specificity for predicting POAF. It also showed an increased risk at higher scores, a score of at least 3 significantly predicted the occurrence of events (p<0.000). Age, male gender, high BMI were significant predictors of POAF (p<0.001, p<0.05, p<0.001). Patients who received statins preoperatively were at significant lower risk (p<0.001). Conclusion: The CHA2DS2-VASc score is a strong predictor of adverse events postoperatively.