Poor asthma education and medication compliance are associated with increased emergency department visits by asthmatic children

Acute exacerbations of bronchial asthma remain a major cause of frequent Emergency Department [ED] visits by pediatric patients. However, other factors including psychosocial, behavioural and educational, are also reportedly associated with repetitive ED visits. Therefore, it is necessary to determine whether such visits are justifiable. The objective of this cross-sectional study was to identify risk factors associated with visits to ED by asthmatic children. Asthmatic children [n= 297] between 1-17 years old were recruited and information collected at the time of visiting an ED facility at two major hospitals. Asthmatic patients visited the ED 3.9 3.2 times-per-year, on average. Inadequately controlled asthma was perceived in 60.3% of patients. The majority of patients [56.4%] reported not receiving education about asthma. Patients reflected misconceptions about the ED department, including the belief that more effective treatments are available [40.9%], or that the ED staff is better qualified [27.8%]. About half of patients [48.2%] visited the ED because of the convenience of being open 24 hours, or because they are received immediately [38.4%]. Uncontrolled asthma was associated with poor education about asthma and/or medication use. Patients educated about asthma, were less likely to stop corticosteroid therapy when their symptoms get better [OR:0.55; 95% CI:0.3-0.9;P= 0.04]. This study reports that most patients had poor knowledge about asthma and were using medications improperly, thus suggesting inefficient application of management action plan. Unnecessary and frequent visits to the ED for asthma care was associated with poor education about asthma and medication use. Potential deficiencies of the health system at directing patients to the proper medical facility were uncovered and underline the necessity to improve education about the disease and medication compliance of patients and their parents/guardians

Relationship of high sensitivity C-reactive protein with cardiac biomarkers in patients presenting with acute coronary syndrome

Objective: To determine high sensitivity C-reactive protein [hsCRP] levels in patients with acute myocardial infarction [AMI] and its correlation with classical enzyme markers of myocardial damage. Study Design: Observational study. Place and Duration of Study: Department of Emergency Medicine at King Khalid University Hospital, King Saud University, Riyadh and Department of Physiology, from August 2010 to December 2011

Methodology: Consecutive eligible patients with either ST elevation myocardial infarction [STEMI] or non-ST elevation myocardial infarction [NSTEMI] who were admitted to the Emergency Department of King Khalid University Hospital were recruited. A total of 71 subjects were finally selected for the study. The hsCRP, Troponin I [Trop I], creatine kinase myocardial bound [CK-MB], aspartate aminotransferase [AST] and lactate dehydrogenase [LDH] concentrations of all patients with an acute myocardial infarction [AMI] were measured

Results: Among all patients 34 [47.9%] patients had diabetes mellitus, 21 [29.6%] were hypertensive, and 16 [22.5%] had no associated illness. Patients with STEMI had significantly higher levels of CKMB [p=0.0348], LDH [p=0.0471] and hsCRP [p=0.0231] compared to NSTEMI patients. While the differences were non-significant for Trop I [p=0.7022], AST [p=0.9729] and Lp[a] [p=0.5985]. Spearman's correlations revealed that CRP correlated significantly with Trop I, CK-MB and LDH. There was a significant predictive relationship of hsCRP with Trop I, LDH and CK-MB while with AST it was nonsignificant

Conclusion: High sensitivity CRP levels is a significant predictor of standard markers for myocardial damage and it may be a useful prognostic marker in acute coronary syndromes

Lipoprotein [a] is a feature of the presence, diffuseness, and severity of coronary artery disease in Saudi population

To study lipoprotein[a] [Lp[a]] levels in Saudi patients with angiographically defined coronary artery disease and to see its relationship with its severity and diffuseness. This cross sectional study was carried out at King Khalid University Hospital, Riyadh, Saudi Arabia in 2006-2007. One hundred and forty-seven individuals with coronary artery disease [CAD] and 49 healthy individuals matched for age and body mass index were studied. Among CAD patients, 133 underwent angiography. Blood samples were analyzed for total cholesterol [TC], triglycerides [TG], low density lipoprotein [LDL] and high density lipoprotein [HDL] and Lp[a]. Coronary artery disease patients had higher Lp[a] levels than controls [25.78 +/- 25.09mg/dl versus 14.57 +/- 11.81 mg/dl, p=0.0030]. Patients without stenosis [10.97 +/- 8.06mg/dl] and one vessel involvement [19.67 +/- 17.33mg/dl] had significantly lower levels of Lp[a] compared to double [31.88 +/- 32.17mg/dl] and triple [29.70 +/- 28.12mg/dl] vessel disease. Lipoprotein[a] levels correlated significantly with coronary vessel score [r = 0.234, p = 0.033] and Gensini score [r = 0.256, p = 0.02]. Smoking [odds ratio [OR]: 1.86; 95% confidence interval [CI]: 1.020-2.510; p=0.04], TG levels [OR: 2.04; 95% CI: 1.251-4.932; p = 0.03] and Lp[a] levels [OR: 1.56; 95% CI: 1.033-3.687; p = 0.025] significantly predicted CAD severity. High risk levels of Lp[a] >/= 30 mg/dL were present in 66.7% of CAD patients. Lipoprotein[a] levels are significantly higher in Saudi patients with CAD compared to healthy individuals, and are associated with more severe and diffuse blockage of the coronary vessels